189-05: Analysis of the Relationship between Electrical Rotors and Atrial Scar Tissue: Lessons from Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging. (10th June 2016)

• Record Type: Journal Article
• Authors: Sohns, Christian; Fink, Thomas; Lemes, Christine; Chemelevsky, Mikhail; Kivelitz, Dietmar; Maurer, Tilmann; Mathew, Shibu; Reißmann, Bruno; Heeger, Christian-Hendrik; Staab, Wieland; Ouyang, Feifan; Metzner, Andreas; Kuck, Karl-Heinz
• Is Part Of: Europace. Volume 18(2016)Supplement 1
• Page Start: i139
• Page End: i139
• Publication Date: 2016-06-10
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/18.suppl_1.i139b
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of left atrial (LA) scar prior pulmonary vein isolation (PVI). The novel non-invasive epicardial and endocardial electrophysiology system (NEEES) allows for reconstruction of local cardiac unipolar electrograms (EGs) derived from body-surface potentials. NEEES allows for reproducible identification of sources with rotor activity. This study describes a new technique to examine the relationship between electrical rotors and LGE signal intensity (SI) in patients with persistent atrial fibrillation (PERS) scheduled for catheter ablation. Methods: All patients underwent PVI for PERS. LGE CMR of both atria was prospectively performed. Afterwards NEEES-based analysis was performed to identify electrical rotors. For every mapping point, the intracardiac locations were projected onto an individual MRI-derived 3D shell. This allowed the LGE CMR SI to be projected on to the anatomy from the NEEES-based analysis. The image intensity ratio (IIR), and myocardial wall thickness were calculated. The electrical rotors could thus be analyzed as every vertex on the fused shell had an individual LGE label. Results: Ten consecutive patients with PERS were analyzed. NEEES analysis identified a total number of 113 electrical rotors predominantly located in the LA. Out of these, 46% were located in the right atrium (RA) and 54% in the LA. MRI analysis was performed from 10 RA and 10 LA datasets including 86 axial LGE CMR planes for each atrium. A total number of 280250 vertices (11210/atrium) were analyzed on the fused shells. Sources of rotor activity were not directly correlated to any cut-off values of IIR. Mean IIR at a location of an electrical rotor was 1.17 +/- 0.18 and mean atrial wall thickness was 2.35 +/-0.42mm. The mean LA and RA scar burden was 21.2% ± 10% and 18.3% ± 13.2%. Conclusions: This is the first study demonstrating that the presence of electrical rotors based on NEEES-analysis is not directly associated with the extent and location of LGE CMR SI. Further studies evaluating the relationship between rotors and atrial scar tissue in patients with PERS are necessary and may inform strategies to improve ablation outcome.