1
|
Cruz I, Lopes Fernandes S, Diaz SO, Saraiva F, Barros AS, Primo J, Sampaio F, Ladeiras-Lopes R, Fontes-Carvalho R. El tejido adiposo epicárdico no es un predictor independiente de recurrencia de fibrilación auricular tras ablación con catéter. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
2
|
Cruz I, Lopes Fernandes S, Diaz SO, Saraiva F, Barros AS, Primo J, Sampaio F, Ladeiras-Lopes R, Fontes-Carvalho R. Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00315-2. [PMID: 36442797 DOI: 10.1016/j.rec.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Previous studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. METHODS A total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. RESULTS After a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). CONCLUSIONS EAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation.
Collapse
Affiliation(s)
- Inês Cruz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Sílvia O Diaz
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Primo
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Ladeiras-Lopes
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Cardiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| |
Collapse
|
3
|
Li L, Zimmer VA, Schnabel JA, Zhuang X. Medical image analysis on left atrial LGE MRI for atrial fibrillation studies: A review. Med Image Anal 2022; 77:102360. [PMID: 35124370 PMCID: PMC7614005 DOI: 10.1016/j.media.2022.102360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is commonly used to visualize and quantify left atrial (LA) scars. The position and extent of LA scars provide important information on the pathophysiology and progression of atrial fibrillation (AF). Hence, LA LGE MRI computing and analysis are essential for computer-assisted diagnosis and treatment stratification of AF patients. Since manual delineations can be time-consuming and subject to intra- and inter-expert variability, automating this computing is highly desired, which nevertheless is still challenging and under-researched. This paper aims to provide a systematic review on computing methods for LA cavity, wall, scar, and ablation gap segmentation and quantification from LGE MRI, and the related literature for AF studies. Specifically, we first summarize AF-related imaging techniques, particularly LGE MRI. Then, we review the methodologies of the four computing tasks in detail and summarize the validation strategies applied in each task as well as state-of-the-art results on public datasets. Finally, the possible future developments are outlined, with a brief survey on the potential clinical applications of the aforementioned methods. The review indicates that the research into this topic is still in the early stages. Although several methods have been proposed, especially for the LA cavity segmentation, there is still a large scope for further algorithmic developments due to performance issues related to the high variability of enhancement appearance and differences in image acquisition.
Collapse
Affiliation(s)
- Lei Li
- School of Data Science, Fudan University, Shanghai, China; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Veronika A Zimmer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Informatics, Technical University of Munich, Germany
| | - Julia A Schnabel
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Informatics, Technical University of Munich, Germany; Helmholtz Center Munich, Germany
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
El Mahdiui M, Simon J, Smit JM, Kuneman JH, van Rosendael AR, Steyerberg EW, van der Geest RJ, Száraz L, Herczeg S, Szegedi N, Gellér L, Delgado V, Merkely B, Bax JJ, Maurovich-Horvat P. Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation After Catheter Ablation. Circ Arrhythm Electrophysiol 2021; 14:e009135. [PMID: 33720759 DOI: 10.1161/circep.120.009135] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Jeff M Smit
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Jurrien H Kuneman
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences (E.W.S.), Leiden University Medical Center, the Netherlands
| | - Rob J van der Geest
- Division of Image Processing (R.J.v.d.G.), Leiden University Medical Center, the Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Szilvia Herczeg
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - László Gellér
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Bela Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Jeroen J Bax
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary.,Department of Radiology, Medical Imaging Centre (P.M.-H.), Semmelweis University, Budapest, Hungary
| |
Collapse
|
5
|
Abstract
AF is the most common arrhythmia in clinical practice. In addition to the severe effect on quality of life, patients with AF are at higher risk of stroke and mortality. Recent studies have suggested that atrial and ventricular substrate play a major role in the development and maintenance of AF. Cardiac MRI has emerged as a viable tool for interrogating the underlying substrate in AF patients. Its advantage includes localisation and quantification of structural remodelling. Cardiac MRI of the atrial substrate is not only a tool for management and treatment of arrhythmia, but also to individualise the prevention of stroke and major cardiovascular events. This article provides an overview of atrial imaging using cardiac MRI and its clinical implications in the AF population.
Collapse
Affiliation(s)
- Yan Zhao
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Lilas Dagher
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Chao Huang
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Peter Miller
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| | - Nassir F Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular Institute, Tulane University School of Medicine, LA, US
| |
Collapse
|
6
|
Laţcu DG, Bun SS, Casado Arroyo R, Wedn AM, Benaich FA, Hasni K, Enache B, Saoudi N. Scar identification, quantification, and characterization in complex atrial tachycardia: a path to targeted ablation? Europace 2020; 21:i21-i26. [PMID: 30801130 DOI: 10.1093/europace/euy182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/23/2018] [Indexed: 01/21/2023] Open
Abstract
Successful catheter ablation of scar-related atrial tachycardia depends on correct identification of the critical isthmus. Often, this is a represented by a small bundle of viable conducting tissue within a low-voltage area. It's identification depends on the magnitude of the signal/noise ratio. Ultra-high density mapping, multipolar catheters with small (eventually unidirectional) and closely-spaced electrodes improves low-voltage electrogram detection. Background noise limitation is also of major importance for improving the signal/noise ratio. Electrophysiological properties of the critical isthmus and the characteristics of the local bipolar electrograms have been recently demonstrated as hallmarks of successful ablation sites in the setting of scar-related atrial tachycardia.
Collapse
Affiliation(s)
| | - Sok-Sithikun Bun
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Ruben Casado Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ahmed Moustfa Wedn
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | | | - Karim Hasni
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Bogdan Enache
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| | - Nadir Saoudi
- Service de Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur, Monaco
| |
Collapse
|
7
|
Kamali R, Schroeder J, DiBella E, Steinberg B, Han F, Dosdall DJ, Macleod RS, Ranjan R. Reproducibility of clinical late gadolinium enhancement magnetic resonance imaging in detecting left atrial scar after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:2824-2832. [PMID: 32931635 DOI: 10.1111/jce.14743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (MRI) can be used to detect postablation atrial scar (PAAS) but its reproducibility and reliability in clinical scans across different magnetic flux densities and scar detection methods are unknown. METHODS Patients (n = 45) having undergone two consecutive MRIs (3 months apart) on 3T and 1.5T scanners were studied. We compared PAAS detection reproducibility using four methods of thresholding: simple thresholding, Otsu thresholding, 3.3 standard deviations (SD) above blood pool (BP) mean intensity, and image intensity ratio (IIR). We performed a texture study by dividing the left atrial wall intensity histogram into deciles and evaluated the correlation of the same decile of the two scans as well as to a randomized distribution of intensities, quantified using Dice Similarity Coefficient (DSC). RESULTS The choice of scanner did not significantly affect the reproducibility. The scar detection performed by Otsu thresholding (DSC of 71.26 ± 8.34) resulted in a better correlation of the two scans compared with the methods of 3.3 SD above BP mean intensity (DSC of 57.78 ± 21.2, p < .001) and IIR above 1.61 (DSC of 45.76 ± 29.55, p <.001). Texture analysis showed that correlation only for voxels with intensities in deciles above the 70th percentile of wall intensity histogram was better than random distribution (p < .001). CONCLUSIONS Our results demonstrate that clinical LGE-MRI can be reliably used for visualizing PAAS across different magnetic flux densities if the threshold is greater than 70th percentile of the wall intensity distribution. Also, atrial wall-based thresholding is better than BP-based thresholding for reproducible PAAS detection.
Collapse
Affiliation(s)
- Roya Kamali
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, USA
| | - Joyce Schroeder
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Edward DiBella
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin Steinberg
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Frederick Han
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Rob S Macleod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA.,Nora Eccles Harrison Cardiovascular Research and Training Institute, Salt Lake City, Utah, USA
| |
Collapse
|
8
|
Henningsson M, Carlhäll CJ. Inflow artifact reduction using an adaptive flip-angle navigator restore pulse for late gadolinium enhancement of the left atrium. Magn Reson Med 2020; 84:3308-3315. [PMID: 32459007 DOI: 10.1002/mrm.28334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Late gadolinium enhancement (LGE) of the left atrium is susceptible to artifacts arising from the right pulmonary veins, caused by inflowing blood tagged by the navigator restore pulse. The purpose of this study was to evaluate a new method to reduce the inflow artifact using an adaptive flip-angle restore pulse. METHODS A low-restore angle reduces the inflow artifact but may lead to a poor navigator SNR. The proposed approach aims to determine the patient-specific restore angle, which optimizes the trade-off between inflow artifacts and navigator SNR. Three-dimensional LGE with adaptive navigator restore (3D LGEA ) was implemented by incrementing the flip angle of the restore pulse from a starting value of 0°, based on the navigator normalized cross-correlation. Magnetic resonance imaging experiments were performed on a 1.5T scanner. The value of 3D LGEA was compared with 3D LGE with a constant 180° restore pulse (3D LGE180 ) in 22 patients with heart diseases. The values of 3D LGEA and 3D LGE180 were compared in terms of pulmonary vein blood signal relative to reference blood in the descending aorta (PVrel ) and visual scoring to determine level of motion artifacts using a 4-point scale (1 = severe artifacts; 4 = no artifacts). RESULTS The value of PVrel was significantly lower for 3D LGEA than for 3D LGE180 (1.16 ± 0.23 vs. 1.59 ± 0.29, P < .001). Furthermore, visual scoring of the motion artifacts yielded no difference (P = .78). CONCLUSION Adaptively adjusting the navigator restore flip angle based on the navigator normalized cross-correlation reduces the 3D LGE inflow artifact without affecting image quality or the scan time.
Collapse
Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
9
|
Aparina OP, Mironov NY, Fedorova EA, Dzaurova KM, Maikov EB, Stukalova OV, Golitsyn SP. [Cardiac magnetic resonance imaging with contrast enhancement in treatment of atrial fibrillation]. ACTA ACUST UNITED AC 2020; 60:119-125. [PMID: 32375624 DOI: 10.18087/cardio.2020.3.n582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
Catheter ablation is presently the main method for interventional treatment of atrial fibrillation (AF). Despite improvements of the method and accumulation of personnel's experience, incidence of recurrent AF following catheter interventions remains high. This review addresses a possibility of using contrast-enhanced cardiac magnetic resonance imaging to increase the effectiveness of interventional treatment of arrhythmia.
Collapse
Affiliation(s)
- O P Aparina
- National Medical Research Center of Cardiology
| | | | | | | | - E B Maikov
- National Medical Research Center of Cardiology
| | | | | |
Collapse
|
10
|
Linhart M, Alarcon F, Borràs R, Benito EM, Chipa F, Cozzari J, Caixal G, Enomoto N, Carlosena A, Guasch E, Arbelo E, Tolosana JM, Prat-Gonzalez S, Perea RJ, Doltra A, Sitges M, Brugada J, Berruezo A, Mont L. Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006659. [PMID: 30562102 DOI: 10.1161/circep.118.006659] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.
Collapse
Affiliation(s)
- Markus Linhart
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Francisco Alarcon
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Roger Borràs
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eva M Benito
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Fredy Chipa
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Jennifer Cozzari
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Gala Caixal
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Norihiro Enomoto
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Alicia Carlosena
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Eduard Guasch
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Elena Arbelo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Jose Maria Tolosana
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Susana Prat-Gonzalez
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.)
| | - Rosario J Perea
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Adelina Doltra
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.)
| | - Marta Sitges
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Josep Brugada
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Antonio Berruezo
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| | - Lluís Mont
- Institut Clínic de Malalties Cardiovasculars, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.Z., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (M.L., F.A., R.B., E.M.B., F.C., J.C., G.C., N.E., A.C., E.G., E.A., J.M.T., S.P.-G., R.J.P., A.D., M.S., J.B., A.B., L.M.).,Unitat de Fibril.lació Auricular (UFA), Hospital Clínic de Barcelona, Catalonia, Spain (E.M.B., G.C., E.G., E.A., S.P.-G., M.S., L.M.).,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain (E.G., E.A., J.M.T., M.S., J.B., A.B., L.M.)
| |
Collapse
|
11
|
Korodi S, Toganel R, Benedek T, Hodas R, Chitu M, Ratiu M, Kovacs I, Mester A, Benedek I. Impact of inflammation-mediated myocardial fibrosis on the risk of recurrence after successful ablation of atrial fibrillation - the FIBRO-RISK study: Protocol for a non-randomized clinical trial. Medicine (Baltimore) 2019; 98:e14504. [PMID: 30817568 PMCID: PMC6831404 DOI: 10.1097/md.0000000000014504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Interventional ablation has been demonstrated to represent an effective therapy in patients with atrial fibrillation (AF), leading to restoration and maintenance of sinus rhythm in the majority of cases. However, recurrence of AF is encountered in 35% to 40% of cases, and the causes for this frequent complication have not been elucidated so far. MATERIAL AND METHODS Here we present the study protocol of the FIBRO-RISK trial, a prospective, single-center, cohort study which aims to investigate the impact of inflammatory-mediated myocardial fibrosis on the risk of recurrence after successful catheter ablation of atrial fibrillation. The level of systemic inflammation in the pre-ablation and immediate post-ablation period will be assessed on the basis of serum levels of inflammatory biomarkers (hsCRP, matrix metalloproteases, interleukin-6), while the level of cardiac fibrosis will be determined based on cardiac magnetic resonance imaging associated with complex post-processing techniques for mapping myocardial fibrosis at the level of left atrium and left ventricle. At the same time, the amount of epicardial fat will serve as an indirect marker of localized inflammation and will be determined at different levels in the heart (surrounding left atrium, right atrium or the entire heart), while ventricular function will be assessed on the basis of serum levels of NT-proBNP prior to the procedure. All these parameters will be investigated in patients with successful ablation of AF, who will be divided into 2 groups: group 1 - patients who develop AF recurrence at 1-year, and group 2 - patients with no recurrence of AF at 1-year. In all patients, the following biomarkers will be determined: serum levels of inflammatory biomarkers and NT-proBNP at 24 hours and 1-year post procedure, the amount of myocardial fibrosis at the level of left atrium and left ventricle at baseline +/- 7 days, and the amount of epicardial fat surrounding left atrium, right atrium and the entire heart at baseline +/- 7 days.The primary endpoint of the study will be represented by the rate of AF recurrence at 1-year post ablation, documented by either ECG or Holter monitoring. The secondary endpoints of the study will consist in:In conclusion, FIBRO-RISK will be the first CMR-based study that will investigate the impact of inflammation-mediated myocardial fibrosis and ventricular remodeling on the risk of recurrence after successful ablation of AF, aiming to validate inflammatory biomarkers and myocardial fibrosis as predictors for AF recurrence.
Collapse
Affiliation(s)
| | - Rodica Toganel
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Theodora Benedek
- University of Medicine, Pharmacy, Sciences and Technology
- Emergency Clinical County Hospital, Tirgu Mures, Romania
| | - Roxana Hodas
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Monica Chitu
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Mihaela Ratiu
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Istvan Kovacs
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Andras Mester
- University of Medicine, Pharmacy, Sciences and Technology
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center
| | - Imre Benedek
- University of Medicine, Pharmacy, Sciences and Technology
- Emergency Clinical County Hospital, Tirgu Mures, Romania
| |
Collapse
|
12
|
New Insights Into the Use of Cardiac Magnetic Resonance Imaging to Guide Decision Making in Atrial Fibrillation Management. Can J Cardiol 2018; 34:1461-1470. [DOI: 10.1016/j.cjca.2018.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022] Open
|
13
|
Chubb H, Lal K, Kiedrowicz R, Karim R, Williams SE, Harrison J, Whitaker J, Wright M, Razavi R, O’Neill M. The value of ablation parameter indices for predicting mature atrial scar formation in humans: An in vivo assessment using cardiac magnetic resonance imaging. J Cardiovasc Electrophysiol 2018; 30:67-77. [DOI: 10.1111/jce.13754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Kulvinder Lal
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | | | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| |
Collapse
|
14
|
Nuñez-Garcia M, Camara O, O'Neill MD, Razavi R, Chubb H, Butakoff C. Mind the gap: Quantification of incomplete ablation patterns after pulmonary vein isolation using minimum path search. Med Image Anal 2018; 51:1-12. [PMID: 30347332 DOI: 10.1016/j.media.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Pulmonary vein isolation (PVI) is a common procedure for the treatment of atrial fibrillation (AF) since the initial trigger for AF frequently originates in the pulmonary veins. A successful isolation produces a continuous lesion (scar) completely encircling the veins that stops activation waves from propagating to the atrial body. Unfortunately, the encircling lesion is often incomplete, becoming a combination of scar and gaps of healthy tissue. These gaps are potential causes of AF recurrence, which requires a redo of the isolation procedure. Late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) is a non-invasive method that may also be used to detect gaps, but it is currently a time-consuming process, prone to high inter-observer variability. In this paper, we present a method to semi-automatically identify and quantify ablation gaps. Gap quantification is performed through minimum path search in a graph where every node is a scar patch and the edges are the geodesic distances between patches. We propose the Relative Gap Measure (RGM) to estimate the percentage of gap around a vein, which is defined as the ratio of the overall gap length and the total length of the path that encircles the vein. Additionally, an advanced version of the RGM has been developed to integrate gap quantification estimates from different scar segmentation techniques into a single figure-of-merit. Population-based statistical and regional analysis of gap distribution was performed using a standardised parcellation of the left atrium. We have evaluated our method on synthetic and clinical data from 50 AF patients who underwent PVI with radiofrequency ablation. The population-based analysis concluded that the left superior PV is more prone to lesion gaps while the left inferior PV tends to have less gaps (p < .05 in both cases), in the processed data. This type of information can be very useful for the optimization and objective assessment of PVI interventions.
Collapse
Affiliation(s)
- Marta Nuñez-Garcia
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Oscar Camara
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mark D O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Constantine Butakoff
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
15
|
Pontecorboli G, Figueras I Ventura RM, Carlosena A, Benito E, Prat-Gonzales S, Padeletti L, Mont L. Use of delayed-enhancement magnetic resonance imaging for fibrosis detection in the atria: a review. Europace 2018; 19:180-189. [PMID: 28172967 DOI: 10.1093/europace/euw053] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
This paper presents a review of the different approaches existing in the literature to detect and quantify fibrosis in contrast-enhanced magnetic resonance images of the left atrial wall. The paper provides a critical analysis of the different methods, stating their advantages and limitations, and providing detailed analysis on the possible sources of variability in the final amount of detected fibrosis coming from the use of different techniques.
Collapse
Affiliation(s)
| | | | | | - Eva Benito
- Hospital Clinic, Universitat de Barcelona, Catalonia, Spain
| | | | - Luigi Padeletti
- Department of Heart and Vessels, University of Florence, Florence, Italy.,IRCCS Multimedica, Milan, Italy
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Catalonia, Spain
| |
Collapse
|
16
|
Chubb H, Aziz S, Karim R, Sohns C, Razeghi O, Williams SE, Whitaker J, Harrison J, Chiribiri A, Schaeffter T, Wright M, O’Neill M, Razavi R. Optimization of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. J Cardiovasc Magn Reson 2018; 20:30. [PMID: 29720202 PMCID: PMC5932811 DOI: 10.1186/s12968-018-0449-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/04/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging may be used to visualize post-ablation atrial scar (PAAS), and three-dimensional late gadolinium enhancement (3D LGE) is the most widely employed technique for imaging of chronic scar. Detection of PAAS provides a unique non-invasive insight into the effects of the ablation and may help guide further ablation procedures. However, there is evidence that PAAS is often not detected by CMR, implying a significant sensitivity problem, and imaging parameters vary between leading centres. Therefore, there is a need to establish the optimal imaging parameters to detect PAAS. METHODS Forty subjects undergoing their first pulmonary vein isolation procedure for AF had detailed CMR assessment of atrial scar: one scan pre-ablation, and two scans post-ablation at 3 months (separated by 48 h). Each scan session included ECG- and respiratory-navigated 3D LGE acquisition at 10, 20 and 30 min post injection of a gadolinium-based contrast agent (GBCA). The first post-procedural scan was performed on a 1.5 T scanner with standard acquisition parameters, including double dose (0.2 mmol/kg) Gadovist and 4 mm slice thickness. Ten patients subsequently underwent identical scan as controls, and the other 30 underwent imaging with a reduced, single, dose GBCA (n = 10), half slice thickness (n = 10) or on a 3 T scanner (n = 10). Apparent signal-to-noise (aSNR), contrast-to-noise (aCNR) and imaging quality (Likert Scale, 3 independent observers) were assessed. PAAS location and area (%PAAS scar) were assessed following manual segmentation. Atrial shells with standardised %PAAS at each timepoint were then compared to ablation lesion locations to assess quality of scar delineation. RESULTS A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. Likert scale of imaging quality had high interobserver and intraobserver intraclass correlation coefficients (0.89 and 0.96 respectively), and showed lower overall imaging quality on 3 T and at half-slice thickness. aCNR, and quality of scar delineation increased significantly with time. aCNR was higher with reduced, single, dose of GBCA (p = 0.005). CONCLUSION 3D LGE CMR atrial scar imaging, as assessed qualitatively and quantitatively, improves with time from GBCA administration, with some indices continuing to improve from 20 to 30 min. Imaging should be performed at least 20 min post-GBCA injection, and a single dose of contrast should be considered. TRIAL REGISTRATION Trial registry- United Kingdom National Research Ethics Service 08/H0802/68 - 30th September 2008.
Collapse
Affiliation(s)
- Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Shadman Aziz
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Christian Sohns
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Tobias Schaeffter
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| |
Collapse
|
17
|
Chubb H, Karim R, Roujol S, Nuñez-Garcia M, Williams SE, Whitaker J, Harrison J, Butakoff C, Camara O, Chiribiri A, Schaeffter T, Wright M, O’Neill M, Razavi R. The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. J Cardiovasc Magn Reson 2018; 20:21. [PMID: 29554919 PMCID: PMC5858144 DOI: 10.1186/s12968-018-0438-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. METHODS Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters ('Repro', n = 10), 3 T scanner ('3 T', n = 10), half-slice thickness ('Half-slice', n = 10) or half GBCA dose ('Half-gad', n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). RESULTS A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for 'Repro' group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454-0.825, PVE 0.618-0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, 'Repro' group). There was no significant relationship between indices of PAAS and AF recurrence. CONCLUSION PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome. TRIAL REGISTRATION United Kingdom National Research Ethics Service 08/H0802/68 - 30th September 2008.
Collapse
Affiliation(s)
- Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Marta Nuñez-Garcia
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Constantine Butakoff
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Tobias Schaeffter
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| |
Collapse
|
18
|
Sun JY, Yun CH, Mok GSP, Liu YH, Hung CL, Wu TH, Alaiti MA, Eck BL, Fares A, Bezerra HG. Left Atrium Wall-mapping Application for Wall Thickness Visualisation. Sci Rep 2018. [PMID: 29520005 PMCID: PMC5843597 DOI: 10.1038/s41598-018-22089-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The measurement method for the LA wall thickness (WT) using cardiac computed tomography (CT) is observer dependent and cannot provide a rapid and comprehensive visualisation of the global LA WT. We aim to develop a LA wall-mapping application to display the global LA WT on a coplanar plane. The accuracy, intra-observer, and inter-observer reproducibility of the application were validated using digital/physical phantoms, and CT images of eight patients. This application on CT-based LA WT measures were further validated by testing six pig cardiac specimens. To evaluate its accuracy, the expanded maps of the physical phantom and pig LA were generated from the CT images and compared with the expanded map of the digital phantom and LA wall of pig heart. No significant differences (p > 0.05) were found between physical phantom and digital phantom as well as pig heart specimen and CT images using our application. Moreover, the analysis was based on the LA physical phantom or images of clinical patients; the results consistently demonstrated high intra-observer reproducibility (ICC > 0.9) and inter-observer reproducibility (ICC > 0.8) and showed good correlation between measures of pig heart specimen and CT data (r = 0.96, p < 0.001). The application can process and analyse the LA architecture for further visualisation and quantification.
Collapse
Affiliation(s)
- Jing-Yi Sun
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan.,Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, SAR, China
| | - Yi-Hwa Liu
- Department of Internal Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, and Mackay Medicine Nursing and Management College, Taipei, Taiwan. .,Department of Internal Medicine (Cardiology), Mackay Memorial Hospital, Taipei, Taiwan. .,Institute of Clinical Medicine, and Cardiovascular Research Center, Taipei, Taiwan.
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.
| | - Mohamad Amer Alaiti
- Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Brendan L Eck
- Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Anas Fares
- Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Hiram G Bezerra
- Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, OH, USA
| |
Collapse
|
19
|
Lam A, Okene E, Parikh A, Zhong X, Tejada T, Hoskins M, Lloyd M, Oshinski JN. Combined Angiography and Late Gadolinium Enhancement Acquisition to Improve Assessment of Pulmonary Vein Isolation for Atrial Fibrillation. J Magn Reson Imaging 2017; 47:477-486. [PMID: 28556294 DOI: 10.1002/jmri.25771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/09/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop a Shared K-space (SharK) magnetic resonance imaging (MRI) sequence that combines angiographic and late gadolinium enhancement (LGE) acquisitions to improve atrial wall segmentation and scar identification, and to develop a novel visualization method that quantifies scar encirclement of pulmonary veins postablation treatment for atrial fibrillation. MATERIALS AND METHODS A SharK sequence was developed and used at 3T to image the left atrium in 11 patients postcryoballoon ablation. The effects of sharing k-space between the angiographic and LGE acquisitions on the accuracy of scar were assessed. The left atrial wall was segmented and points about each pulmonary vein (PV) ostia were projected onto a bullseye to quantitatively compare PV encirclement. The parameters used to quantify encirclement were varied to perform a sensitivity analysis. RESULTS Compared to using a complete set of k-space, total atrial scar differences were significant only when sharing >75% k-space (P = 0.014), and 90% sensitivity and specificity for identifying scar was achieved when sharing 50% k-space. In patients, the right PVs showed more intersubject variance in encirclement compared to the left PVs. A 100° anteroinferior portion of the left PVs was always encircled, while the superior segments of both right PVs was ablated in only 6/11 patients. CONCLUSION A SharK sequence was developed to combine angiographic and LGE imaging for atrial wall segmentation and scar identification. The PV bullseye quantifies and localizes encirclement about the PVs. The left PVs showed a higher amount of scar encirclement and less variability compared to the right PVs. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:477-486.
Collapse
Affiliation(s)
- Adrian Lam
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Erica Okene
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Ankit Parikh
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Xiaodong Zhong
- MR R&D Collaborations, Siemens Healthcare, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Thor Tejada
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Michael Hoskins
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Michael Lloyd
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - John N Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.,Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
20
|
|
21
|
Giannakidis A, Nyktari E, Keegan J, Pierce I, Suman Horduna I, Haldar S, Pennell DJ, Mohiaddin R, Wong T, Firmin DN. Rapid automatic segmentation of abnormal tissue in late gadolinium enhancement cardiovascular magnetic resonance images for improved management of long-standing persistent atrial fibrillation. Biomed Eng Online 2015; 14:88. [PMID: 26445883 PMCID: PMC4596471 DOI: 10.1186/s12938-015-0083-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/21/2015] [Indexed: 01/11/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common heart rhythm disorder. In order for late Gd enhancement cardiovascular magnetic resonance (LGE CMR) to ameliorate the AF management, the ready availability of the accurate enhancement segmentation is required. However, the computer-aided segmentation of enhancement in LGE CMR of AF is still an open question. Additionally, the number of centres that have reported successful application of LGE CMR to guide clinical AF strategies remains low, while the debate on LGE CMR’s diagnostic ability for AF still holds. The aim of this study is to propose a method that reliably distinguishes enhanced (abnormal) from non-enhanced (healthy) tissue within the left atrial wall of (pre-ablation and 3 months post-ablation) LGE CMR data-sets from long-standing persistent AF patients studied at our centre. Methods Enhancement segmentation was achieved by employing thresholds benchmarked against the statistics of the whole left atrial blood-pool (LABP). The test-set cross-validation mechanism was applied to determine the input feature representation and algorithm that best predict enhancement threshold levels. Results Global normalized intensity threshold levels TPRE = 1 1/4 and TPOST = 1 5/8 were found to segment enhancement in data-sets acquired pre-ablation and at 3 months post-ablation, respectively. The segmentation results were corroborated by using visual inspection of LGE CMR brightness levels and one endocardial bipolar voltage map. The measured extent of pre-ablation fibrosis fell within the normal range for the specific arrhythmia phenotype. 3D volume renderings of segmented post-ablation enhancement emulated the expected ablation lesion patterns. By comparing our technique with other related approaches that proposed different threshold levels (although they also relied on reference regions from within the LABP) for segmenting enhancement in LGE CMR data-sets of AF patients, we illustrated that the cut-off levels employed by other centres may not be usable for clinical studies performed in our centre. Conclusions The proposed technique has great potential for successful employment in the AF management within our centre. It provides a highly desirable validation of the LGE CMR technique for AF studies. Inter-centre differences in the CMR acquisition protocol and image analysis strategy inevitably impede the selection of a universally optimal algorithm for segmentation of enhancement in AF studies.
Collapse
Affiliation(s)
- Archontis Giannakidis
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Eva Nyktari
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Jennifer Keegan
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Iain Pierce
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Irina Suman Horduna
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Shouvik Haldar
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Dudley J Pennell
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| | - Raad Mohiaddin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - Tom Wong
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
| | - David N Firmin
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK. .,National Heart and Lung Institute, Imperial College London, London, UK.
| |
Collapse
|
22
|
Ipek EG, Nazarian S. Cardiac magnetic resonance for prediction of arrhythmogenic areas. Trends Cardiovasc Med 2015; 25:635-42. [PMID: 25937045 PMCID: PMC4559491 DOI: 10.1016/j.tcm.2015.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
Catheter ablation has been widely used to manage recurrent atrial and ventricular arrhythmias. It has been established that contrast-enhanced magnetic resonance can accurately characterize the myocardium. In this review, we summarize the role of cardiac magnetic resonance in identification of arrhythmogenic substrates, and the potential utility of cardiac magnetic resonance for catheter ablation of complex atrial and ventricular arrhythmias.
Collapse
Affiliation(s)
- Esra Gucuk Ipek
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Saman Nazarian
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
23
|
Nazarian S, Beinart R. CMR-guided targeting of gaps after initial pulmonary vein isolation. JACC Cardiovasc Imaging 2015; 7:664-6. [PMID: 25034916 DOI: 10.1016/j.jcmg.2014.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Saman Nazarian
- Section for Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
| | - Roy Beinart
- Section for Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel
| |
Collapse
|
24
|
Hwang SH, Oh YW, Lee DI, Shim J, Park SW, Kim YH. Relation between left atrial wall composition by late gadolinium enhancement and complex fractionated atrial electrograms in patients with persistent atrial fibrillation: influence of non-fibrotic substrate in the left atrium. Int J Cardiovasc Imaging 2015; 31:1191-9. [DOI: 10.1007/s10554-015-0675-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023]
|
25
|
Jimenez A, Dickfeld TM. Closing the knowledge gaps. Circ Arrhythm Electrophysiol 2015; 8:252-5. [PMID: 25900986 DOI: 10.1161/circep.115.002783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alejandro Jimenez
- From the Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (A.J.); and University of Maryland Medical Center, VA Baltimore and Maryland Arrhythmia and Cardiac Imaging Group (MACIG) (T.M.D.)
| | - Timm M Dickfeld
- From the Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (A.J.); and University of Maryland Medical Center, VA Baltimore and Maryland Arrhythmia and Cardiac Imaging Group (MACIG) (T.M.D.).
| |
Collapse
|
26
|
Rashid S, Rapacchi S, Shivkumar K, Plotnik A, Finn JP, Hu P. Modified wideband three-dimensional late gadolinium enhancement MRI for patients with implantable cardiac devices. Magn Reson Med 2015; 75:572-84. [PMID: 25772155 DOI: 10.1002/mrm.25601] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 01/03/2023]
Abstract
PURPOSE To study the effects of cardiac devices on three-dimensional (3D) late gadolinium enhancement (LGE) MRI and to develop a 3D LGE protocol for implantable cardioverter defibrillator (ICD) patients with reduced image artifacts. THEORY AND METHODS The 3D LGE sequence was modified by implementing a wideband inversion pulse, which reduces hyperintensity artifacts, and by increasing bandwidth of the excitation pulse. The modified wideband 3D LGE sequence was tested in phantoms and evaluated in six volunteers and five patients with ICDs. RESULTS Phantom and in vivo studies results demonstrated extended signal void and ripple artifacts in 3D LGE that were associated with ICDs. The reason for these artifacts was slab profile distortion and the subsequent aliasing in the slice-encoding direction. The modified wideband 3D LGE provided significantly reduced ripple artifacts than 3D LGE with wideband inversion only. Comparison of 3D and 2D LGE images demonstrated improved spatial resolution of the heart using 3D LGE. CONCLUSION Increased bandwidth of the inversion and excitation pulses can significantly reduce image artifacts associated with ICDs. Our modified wideband 3D LGE protocol can be readily used for imaging patients with ICDs given appropriate safety guidelines are followed.
Collapse
Affiliation(s)
- Shams Rashid
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kalyanam Shivkumar
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Adam Plotnik
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Biomedical Physics Inter-Departmental Graduate Program, University of California, Los Angeles, California, USA
| |
Collapse
|
27
|
Hinojar R, Botnar R, Kaski JC, Prasad S, Nagel E, Puntmann VO. Individualized cardiovascular risk assessment by cardiovascular magnetic resonance. Future Cardiol 2015; 10:273-89. [PMID: 24762254 DOI: 10.2217/fca.13.102] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is gaining clinical importance in preventive medicine. Evidence on diagnostic accuracy and prognostic value, in addition to the development of faster imaging, increased availability of equipment and imaging expertise have led to a wide-spread use of CMR in a growing number of clinical indications. The first part of this review summarizes the role of CMR biomarkers for risk assessment focusing on the patients groups that benefit from the use of CMR. In the second part, the future directions for CMR are discussed and their role in prevention of cardiovascular disease.
Collapse
Affiliation(s)
- Rocio Hinojar
- Cardiovascular Imaging Department, Division of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | | | | | | | | | | |
Collapse
|
28
|
Comparison of preexisting and ablation-induced late gadolinium enhancement on left atrial magnetic resonance imaging. Heart Rhythm 2014; 12:668-72. [PMID: 25533586 DOI: 10.1016/j.hrthm.2014.12.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Postablation atrial fibrillation recurrence is positively associated with the extent of preexisting left atrial (LA) late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI), but negatively associated with the extent of postablation LGE regardless of proximity to the pulmonary vein antra. The characteristics of pre- vs postablation LA LGE may provide insight into this seeming paradox and inform future strategies for ablation. OBJECTIVE The purpose of this study was to define the characteristics of preexisting vs ablation-induced LA LGE. METHODS LGE-MRI was prospectively performed before and ≥3 months after initial ablation in 20 patients. The intracardiac locations of ablation points were coregistered with the corresponding sites on axial planes of postablation LGE-MRI. The image intensity ratio (IIR), defined as the LA myocardial MRI signal intensity divided by the mean LA blood pool intensity, and LA myocardial wall thickness were calculated on pre- and postablation images. RESULTS Imaging data from 409 pairs of pre- and postablation axial LGE-MRI planes and 6961 pairs of pre- and postablation image sectors were analyzed. Ablation-induced LGE revealed a higher IIR, suggesting greater contrast uptake and denser fibrosis, than did preexisting LGE (1.25 ± 0.25 vs 1.14 ± 0.15; P < .001). In addition, ablation-induced LGE regions had thinner LA myocardium (2.10 ± 0.67 mm vs 2.37 ± 0.74 mm; P < .001). CONCLUSION Regions with ablation-induced LGE exhibit increased contrast uptake, likely signifying higher scar density, and thinner myocardium as compared with regions with preexisting LGE. Future studies examining the association of postablation LGE intensity and nonuniformity with ablation success are warranted and may inform strategies to optimize ablation outcome.
Collapse
|
29
|
Rolf S, Hindricks G, Sommer P, Richter S, Arya A, Bollmann A, Kosiuk J, Koutalas E. Electroanatomical mapping of atrial fibrillation: Review of the current techniques and advances. J Atr Fibrillation 2014; 7:1140. [PMID: 27957132 PMCID: PMC5135200 DOI: 10.4022/jafib.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/07/2023]
Abstract
The number of atrial fibrillation (AF) catheter ablations performed annually has been increasing exponentially in the western countries in the last few years. This is clearly related to technological advancements, which have greatly contributed to the improvements in catheter ablation of AF. In particular, state-of-the-art electroanatomical mapping systems have greatly facilitated mapping processes and have enabled complex AF ablation strategies. In this review, we outline contemporary and upcoming electroanatomical key technologies focusing on new mapping tools and strategies in the context of AF catheter ablation.
Collapse
Affiliation(s)
- Sascha Rolf
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Gerhard Hindricks
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Philipp Sommer
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Sergio Richter
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Arash Arya
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Andreas Bollmann
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Jedrzej Kosiuk
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| | - Emmanuel Koutalas
- University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig, Germany
| |
Collapse
|
30
|
Roujol S, Foppa M, Basha TA, Akçakaya M, Kissinger KV, Goddu B, Berg S, Nezafat R. Accelerated free breathing ECG triggered contrast enhanced pulmonary vein magnetic resonance angiography using compressed sensing. J Cardiovasc Magn Reson 2014; 16:91. [PMID: 25416082 PMCID: PMC4240816 DOI: 10.1186/s12968-014-0091-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate the feasibility of accelerated electrocardiogram (ECG)-triggered contrast enhanced pulmonary vein magnetic resonance angiography (CE-PV MRA) with isotropic spatial resolution using compressed sensing (CS). METHODS Nineteen patients (59±13 y, 11 M) referred for MR were scanned using the proposed accelerated free breathing ECG-triggered 3D CE-PV MRA sequence (FOV=340×340×110 mm3, spatial resolution=1.5×1.5×1.5 mm3, acquisition window=140 ms at mid diastole and CS acceleration factor=5) and a conventional first-pass breath-hold non ECG-triggered 3D CE-PV MRA sequence. CS data were reconstructed offline using low-dimensional-structure self-learning and thresholding reconstruction (LOST) CS reconstruction. Quantitative analysis of PV sharpness and subjective qualitative analysis of overall image quality were performed using a 4-point scale (1: poor; 4: excellent). RESULTS Quantitative PV sharpness was increased using the proposed approach (0.73±0.09 vs. 0.51±0.07 for the conventional CE-PV MRA protocol, p<0.001). There were no significant differences in the subjective image quality scores between the techniques (3.32±0.94 vs. 3.53±0.77 using the proposed technique). CONCLUSIONS CS-accelerated free-breathing ECG-triggered CE-PV MRA allows evaluation of PV anatomy with improved sharpness compared to conventional non-ECG gated first-pass CE-PV MRA. This technique may be a valuable alternative for patients in which the first pass CE-PV MRA fails due to inaccurate first pass timing or inability of the patient to perform a 20-25 seconds breath-hold.
Collapse
Affiliation(s)
- Sébastien Roujol
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Murilo Foppa
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Tamer A Basha
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Mehmet Akçakaya
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Kraig V Kissinger
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Sophie Berg
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
| |
Collapse
|
31
|
Evaluation of quantification methods for left arial late gadolinium enhancement based on different references in patients with atrial fibrillation. Int J Cardiovasc Imaging 2014; 31 Suppl 1:91-101. [PMID: 25367893 DOI: 10.1007/s10554-014-0563-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/23/2014] [Indexed: 12/19/2022]
Abstract
By using late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging, we compared left atrial late gadolinium enhancement (LA-LGE) quantification methods based on different references to characterize the left atrial wall in patients with atrial fibrillation (AF). Thirty-eight patients who underwent three-dimensional LGE-CMR imaging before catheter ablation for AF were classified into three groups depending on their clinical AF type: (1) paroxysmal AF (PAF; n = 12); (2) persistent AF (PeAF; n = 16); and (3) recurrent AF after catheter ablation (RAF; n = 10). To quantify LA-LGE on LGE-CMR imaging, we used the thresholds of 2 standard deviations (2-SD), 3-SD, 4-SD, 5-SD, or 6-SD above the mean signal from the unenhanced left ventricular myocardium, and we used the full width at half maximum (FWHM) technique, which was based on the maximum signal from the mitral valve with high signal intensity. The 6-SD threshold and FWHM techniques were statistically reproducible with an intraclass correlation coefficient >0.7. On applying the FWHM technique, the normalized LA-LGE volume by LA wall area showed a significant difference between the RAF, PeAF, and PAF groups (0.22 ± 0.04, 0.16 ± 0.06, and 0.09 ± 0.03 mL/cm(2), respectively) (P < 0.05). Furthermore, most of the fibrotic scarring and low-voltage tissue on the electroanatomic map corresponded well with the extent of LA-LGE. The FWHM technique based on the mitral valve can provide a reproducible quantification of LA-LGE related to AF in the thin LA wall.
Collapse
|
32
|
Hsing J, Peters DC, Knowles BR, Manning WJ, Josephson ME. Cardiovascular magnetic resonance imaging of scar development following pulmonary vein isolation: a prospective study. PLoS One 2014; 9:e104844. [PMID: 25251403 PMCID: PMC4174508 DOI: 10.1371/journal.pone.0104844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (MR) provides non-invasive assessment of early (24-hour) edema and injury following pulmonary vein isolation (by ablation) and subsequent scar formation. We hypothesize that 24-hours after ablation, cardiovascular MR would demonstrate a pattern of edema and injury due to ablation and the severity would correlate with subsequent scar. Methods Fifteen atrial fibrillation patients underwent cardiovascular MR prior to pulmonary vein isolation, 24-hours post (N = 11) and 30-days post (N = 7) ablation, with T2-weighted (T2W) and late gadolinium enhancement (LGE) imaging. Left atrial wall thickness, edema enhancement ratio and LGE enhancement were assessed at each time point. Volumes of LGE and edema enhancement were measured, and the circumferential presence of injury was assessed at 24-hours, including comparison with LGE enhancement at 30 days. Results Left atrial wall thickness was increased 24-hours post-ablation (10.7±4.1 mm vs. 7.0±1.8 mm pre-PVI, p<0.05). T2W enhancement at 24-hours showed increased edema enhancement ratio (1.5±0.4 for post-ablation, vs. 0.9±0.2 pre-ablation, p<0.001). Edema and LGE volumes at 24-hours were correlated with 30-day LGE volume (R = 0.76, p = 0.04, and R = 0.74, p = 0.09, respectively). Using a 16 segment model for assessment, 24-hour T2W had sensitivity, specificity, and accuracy of 82%, 63%, and 79% respectively, for predicting 30-day LGE. 24-hour LGE had sensitivity, specificity, and accuracy of 91%, 47%, and 84%. Conclusions Increased left atrial wall thickening and edema were characterized on cardiovascular MR early post-ablation, and found to correlate with 30-day LGE scar.
Collapse
Affiliation(s)
- Jeff Hsing
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dana C. Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Yale Medical School, New Haven, Connecticut, United States of America
- * E-mail:
| | - Benjamin R. Knowles
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark E. Josephson
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
33
|
Singh SM, Jimenez-Juan L, Danon A, Bastarrika G, Shmatukha AV, Wright GA, Crystal E. Magnetic resonance imaging of the left atrial appendage post pulmonary vein isolation: Implications for percutaneous left atrial appendage occlusion. J Arrhythm 2014; 31:108-13. [PMID: 26336541 DOI: 10.1016/j.joa.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 08/12/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is increasing interest in performing left atrial appendage (LAA) occlusion at the time of atrial fibrillation (AF) ablation procedures. However, to date there has been no description of the acute changes to the LAA immediately following pulmonary vein (PV) isolation and additional left atrium (LA) substrate modification. This study assessed changes in the size and tissue characteristics of the LAA ostium in patients undergoing PV isolation. METHODS This series included 8 patients who underwent cardiovascular magnetic resonance evaluation of the LA with delayed enhancement magnetic resonance imaging and contrast enhanced 3-D magnetic resonance angiography pre-, within 48 h of, and 3 months post ablation. Two independent cardiac radiologists evaluated the ostial LAA diameters and area at each time point in addition to the presence of gadolinium enhancement. RESULTS Compared to pre-ablation values, the respective median differences in oblique diameters and LAA area were +1.8 mm, +1.7 mm, and +0.6 cm(2) immediately post ablation (all NS) and -2.7 mm, -2.3 mm, and -0.5 cm(2) at 3 months (all NS). No delayed enhancement was detected in the LAA post ablation. CONCLUSION No significant change to LAA diameter, area, or tissue characteristics was noted after PV isolation. While these findings suggest the safety and feasibility of concomitant PV isolation and LAA device occlusion, the variability in the degree and direction of change of the LAA measurements highlights the need for further study.
Collapse
Key Words
- AF, atrial fibrillation
- Atrial fibrillation
- CE-3D MRA, contrast enhanced 3-dimensional magnetic resonance angiography
- CMR, cardiovascular magnetic resonance imaging
- Catheter ablation
- DE-MRI, delayed enhancement magnetic resonance imaging
- FOV, field of view
- IR, inversion recovery
- LA, left atrium
- LAA, left atrial appendage
- Left atrial appendage occlusion
- Magnetic resonance imaging
- NEX, number of excitations
- PV, pulmonary vein
- RF, radiofrequency
- TE, echo time
- TR, repetition time
Collapse
Affiliation(s)
- Sheldon M Singh
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Cardiothoracic Division, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Asaf Danon
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Gorka Bastarrika
- Department of Medical Imaging, Cardiothoracic Division, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Andriy V Shmatukha
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Graham A Wright
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada ; Schulich Heart Research Program and Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada ; Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Eugene Crystal
- Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Ontario, Canada
| |
Collapse
|
34
|
Tan TC, Koutsogeorgis ID, Grapsa J, Papadopoulos C, Katsivas A, Nihoyannopoulos P. Left atrium and the imaging of atrial fibrosis: catch it if you can! Eur J Clin Invest 2014; 44:872-81. [PMID: 25066356 DOI: 10.1111/eci.12305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/23/2014] [Indexed: 01/04/2023]
Abstract
Atrial fibrillation is a sustained arrhythmia commonly encountered in clinical practice. It has a high prevalence among the elderly and contributes significantly to the global socio-economic burden. Among many risk factors predisposing to atrial fibrillation is left atrial remodelling and wall fibrosis. Frequently, pathological left atrial wall remodelling and fibrosis results in low atrial compliance and elastance significantly increase the risk of developing permanent atrial fibrillation. We reviewed all literature which employs imaging and left atrial fibrosis and we present all available imaging modalities. Current imaging tools may play a role in the detection of atrial fibrosis, hence providing valuable information for risk stratification and management of patients with atrial fibrillation.
Collapse
Affiliation(s)
- Timothy C Tan
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
35
|
Delineating Atrial Scar by Electroanatomic Voltage Mapping versus Cardiac Magnetic Resonance Imaging: Where to Draw the Line? J Cardiovasc Electrophysiol 2014; 25:1053-6. [DOI: 10.1111/jce.12481] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
36
|
COCHET HUBERT, SCHERR DANIEL, ZELLERHOFF STEPHAN, SACHER FREDERIC, DERVAL NICOLAS, DENIS ARNAUD, KNECHT SEBASTIEN, KOMATSU YUKI, MONTAUDON MICHEL, LAURENT FRANÇOIS, PIESKE BURKERTM, HOCINI MÉLÈZE, HAÏSSAGUERRE MICHEL, JAÏS PIERRE. Atrial Structure and Function 5 Years After Successful Ablation for Persistent Atrial Fibrillation: An MRI Study. J Cardiovasc Electrophysiol 2014; 25:671-9. [DOI: 10.1111/jce.12449] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 11/27/2022]
Affiliation(s)
- HUBERT COCHET
- Department of Cardiovascular Imaging; CHU / Université de Bordeaux; Pessac France
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
| | - DANIEL SCHERR
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
- Division of Cardiology; Department of Medicine; Medical University of Graz; Austria
| | - STEPHAN ZELLERHOFF
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - FREDERIC SACHER
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - NICOLAS DERVAL
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - ARNAUD DENIS
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - SEBASTIEN KNECHT
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - YUKI KOMATSU
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - MICHEL MONTAUDON
- Department of Cardiovascular Imaging; CHU / Université de Bordeaux; Pessac France
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
| | - FRANÇOIS LAURENT
- Department of Cardiovascular Imaging; CHU / Université de Bordeaux; Pessac France
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
| | - BURKERT M. PIESKE
- Division of Cardiology; Department of Medicine; Medical University of Graz; Austria
| | - MÉLÈZE HOCINI
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - MICHEL HAÏSSAGUERRE
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| | - PIERRE JAÏS
- L'Institut de Rythmologie et de Modélisation Cardiaque LIRYC; CHU / Université de Bordeaux / INSERM U1045; Pessac France
- Department of cardiac pacing and electrophysiology; CHU / Université de Bordeaux; Pessac France
| |
Collapse
|
37
|
Parmar BR, Jarrett TR, Burgon NS, Kholmovski EG, Akoum NW, Hu N, Macleod RS, Marrouche NF, Ranjan R. Comparison of left atrial area marked ablated in electroanatomical maps with scar in MRI. J Cardiovasc Electrophysiol 2014; 25:457-463. [PMID: 24383404 DOI: 10.1111/jce.12357] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/09/2013] [Accepted: 12/13/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Three-dimensional electroanatomic mapping (EAM) is routinely used to mark ablated areas during radiofrequency ablation. We hypothesized that, in atrial fibrillation (AF) ablation, EAM overestimates scar formation in the left atrium (LA) when compared to the scar seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI). METHODS AND RESULTS Of the 235 patients who underwent initial ablation for AF at our institution between August 2011 and December 2012, we retrospectively identified 70 patients who had preprocedural magnetic resonance angiography merged with LA anatomy in EAM software and had a 3-month postablation LGE-MRI for assessment of scar. Ablated area was marked intraprocedurally using EAM software and quantified retrospectively. Scarred area was quantified in 3-month postablation LGE-MRI. The mean ablated area in EAM was 30.5 ± 7.5% of the LA endocardial surface and the mean scarred area in LGE-MRI was 13.9 ± 5.9% (P < 0.001). This significant difference in the ablated area marked in the EAM and scar area in the LGE-MRI was present for each of the 3 independent operators. Complete pulmonary vein (PV) encirclement representing electrical isolation was observed in 87.8% of the PVs in EAM as compared to only 37.4% in LGE-MRI (P < 0.001). CONCLUSIONS In AF ablation, EAM significantly overestimates the resultant scar as assessed with a follow-up LGE-MRI.
Collapse
Affiliation(s)
- Bhrigu R Parmar
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Tyler R Jarrett
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Nathan S Burgon
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Eugene G Kholmovski
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Nazem W Akoum
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Nan Hu
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Rob S Macleod
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Nassir F Marrouche
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| | - Ravi Ranjan
- Division of Cardiology, CARMA Center, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
38
|
Spragg DD, Khurram I, Nazarian S. Role of Magnetic Resonance Imaging of Atrial Fibrosis in Atrial Fibrillation Ablation. Arrhythm Electrophysiol Rev 2013; 2:124-7. [PMID: 26835053 DOI: 10.15420/aer.2013.2.2.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/14/2013] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) likely involves a complex interplay between triggering activity, usually from pulmonary vein foci, and maintenance of the arrhythmia by an arrhythmogenic substrate. Both components of AF, triggers and substrate have been linked to atrial fibrosis and attendant changes in atrial electrophysiology. Recently, there has been a growing use of imaging modalities, particularly cardiac magnetic resonance (CMR), to quantify the burden of atrial fibrosis and scar in patients either undergoing AF ablation, or who have recently had the procedure. How to use the CMR derived data is still an open area of investigation. The aim of this article is to summarise what is known as atrial fibrosis, as assessed by traditional catheter-based techniques and newer imaging approaches, and to report on novel efforts from our group to advance the use of CMR in AF ablation patients.
Collapse
Affiliation(s)
- David D Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
| | - Irfan Khurram
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
| |
Collapse
|
39
|
Khurram IM, Beinart R, Zipunnikov V, Dewire J, Yarmohammadi H, Sasaki T, Spragg DD, Marine JE, Berger RD, Halperin HR, Calkins H, Zimmerman SL, Nazarian S. Magnetic resonance image intensity ratio, a normalized measure to enable interpatient comparability of left atrial fibrosis. Heart Rhythm 2013; 11:85-92. [PMID: 24096166 DOI: 10.1016/j.hrthm.2013.10.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The measurement of late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) intensity in arbitrary units limits the objectivity of thresholds for focal scar detection and interpatient comparisons of scar burden. OBJECTIVE To develop and validate a normalized measure, the image intensity ratio (IIR), for the assessment of left atrial (LA) scar on LGE-MRI. METHODS Electrocardiogram- and respiratory-gated 1.5 Tesla LGE-MRI was performed in 75 patients (75% men; 62 ± 8 years) before atrial fibrillation ablation. The local IIR was defined as LA myocardial signal intensity for each of the 20 sectors on contiguous axial image planes divided by the mean LA blood pool image intensity. Intracardiac point-by-point sampled electroanatomic map points were coregistered with the corresponding image sectors. RESULTS The average bipolar voltage for all 8153 electroanatomic map points was 0.9 ± 1.1 mV. In a mixed effects model accounting for within patient clustering, and adjusting for age, LA volume, mass, body mass index, sex, CHA2DS2-VASc score, atrial fibrillation type, history of previous ablations, and contrast delay time, each unit increase in local IIR was associated with 91.3% decrease in bipolar LA voltage (P < .001). Local IIR thresholds of >0.97 and >1.61 corresponded to bipolar voltage <0.5 and <0.1 mV, respectively. CONCLUSIONS Normalization of LGE-MRI intensity by the mean blood pool intensity results in a metric that is closely associated with intracardiac voltage as a surrogate of atrial fibrosis.
Collapse
Affiliation(s)
- Irfan M Khurram
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Roy Beinart
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Jane Dewire
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Hirad Yarmohammadi
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Takeshi Sasaki
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - David D Spragg
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Joseph E Marine
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Ronald D Berger
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Henry R Halperin
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Saman Nazarian
- Department of Medicine/Cardiology, Johns Hopkins University, Baltimore, Maryland.
| |
Collapse
|
40
|
Francis SA, Daly C, Heydari B, Abbasi S, Shah RV, Kwong RY. Cost-effectiveness analysis for imaging techniques with a focus on cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013; 15:52. [PMID: 23767423 PMCID: PMC3707775 DOI: 10.1186/1532-429x-15-52] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/03/2013] [Indexed: 12/19/2022] Open
Abstract
With the need for healthcare cost-containment, increased scrutiny will be placed on new medical therapeutic or diagnostic technologies. Several challenges exist for a new diagnostic test to demonstrate cost-effectiveness. New diagnostic tests differ from therapeutic procedures due to the fact that diagnostic tests do not generally directly affect long-term patient outcomes. Instead, the results of diagnostic tests can influence management decisions for patients and by this route, diagnostic tests indirectly affect long-term outcomes. The benefits from a specific diagnostic technology depend therefore not only on its performance characteristics, but also on other factors such as prevalence of disease, and effectiveness of existing treatments for the disease of interest. We review the concepts and theories of cost-effectiveness analyses (CEA) as they apply to diagnostic tests in general. The limitations of CEA across different study designs and geographic regions are discussed, and we also examine the strengths and weakness of the existing publications where CMR was the focus of CEA compared to other diagnostic options.
Collapse
Affiliation(s)
- Sanjeev A Francis
- Cardiology Division, Department of Medicine, Massuchusetts General Hospital, Boston, MA, USA
| | - Caroline Daly
- Cardiology Division, St. James’ Hospital, Dublin, Ireland
| | - Bobak Heydari
- Department of Medicine, Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | - Siddique Abbasi
- Department of Medicine, Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | - Ravi V Shah
- Department of Medicine, Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| | - Raymond Y Kwong
- Department of Medicine, Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA
| |
Collapse
|
41
|
Malcolme-Lawes LC, Juli C, Karim R, Bai W, Quest R, Lim PB, Jamil-Copley S, Kojodjojo P, Ariff B, Davies DW, Rueckert D, Francis DP, Hunter R, Jones D, Boubertakh R, Petersen SE, Schilling R, Kanagaratnam P, Peters NS. Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: a 2-center study. Heart Rhythm 2013; 10:1184-91. [PMID: 23685170 PMCID: PMC3734347 DOI: 10.1016/j.hrthm.2013.04.030] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND For late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) assessment of atrial scar to guide management and targeting of ablation in atrial fibrillation (AF), an objective, reproducible method of identifying atrial scar is required. OBJECTIVE To describe an automated method for operator-independent quantification of LGE that correlates with colocated endocardial voltage and clinical outcomes. METHODS LGE CMR imaging was performed at 2 centers, before and 3 months after pulmonary vein isolation for paroxysmal AF (n = 50). A left atrial (LA) surface scar map was constructed by using automated software, expressing intensity as multiples of standard deviation (SD) above blood pool mean. Twenty-one patients underwent endocardial voltage mapping at the time of pulmonary vein isolation (11 were redo procedures). Scar maps and voltage maps were spatially registered to the same magnetic resonance angiography (MRA) segmentation. RESULTS The LGE levels of 3, 4, and 5SDs above blood pool mean were associated with progressively lower bipolar voltages compared to the preceding enhancement level (0.85 ± 0.33, 0.50 ± 0.22, and 0.38 ± 0.28 mV; P = .002, P < .001, and P = .048, respectively). The proportion of atrial surface area classified as scar (ie, >3 SD above blood pool mean) on preablation scans was greater in patients with postablation AF recurrence than those without recurrence (6.6% ± 6.7% vs 3.5% ± 3.0%, P = .032). The LA volume >102 mL was associated with a significantly greater proportion of LA scar (6.4% ± 5.9% vs 3.4% ± 2.2%; P = .007). CONCLUSIONS LA scar quantified automatically by a simple objective method correlates with colocated endocardial voltage. Greater preablation scar is associated with LA dilatation and AF recurrence.
Collapse
Affiliation(s)
- L C Malcolme-Lawes
- Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Spragg D. Left Atrial Fibrosis: Role in Atrial Fibrillation Pathophysiology and Treatment Outcomes. J Atr Fibrillation 2013; 5:810. [PMID: 28496835 DOI: 10.4022/jafib.810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 01/07/2023]
Abstract
The mechanisms of atrial fibrillation are complex, and have been the subject of intensive study for over fifty years. There is likely a complex interplay between triggers and substrate that mediates the initiation and maintenance of AF. Increasingly, atrial fibrosis has been recognized as a key component of that substrate, playing a critical role in conduction abnormalities in the left atrium that appear necessary to maintaining AF. In the last several years, our abilities to quantify left atrial fibrosis - both through catheter- and MRI-based techniques - has shed important light on the underlying mechanisms of AF, and on therapeutic strategies to treat AF. Whether our increased appreciation of the role of atrial fibrosis in AF translates into improved efficacy of catheter ablation or anti-arrhythmic therapy, though, remains to be seen. The aim of this review is to summarize clinical investigations of atrial fibrosis as a factor in the development and treatment of atrial fibrillation.
Collapse
Affiliation(s)
- David Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| |
Collapse
|
43
|
HUNTER ROSSJ, JONES DANIELA, BOUBERTAKH REDHA, MALCOLME-LAWES LOUISAC, KANAGARATNAM PRAPA, JULI CHRISTOPHF, DAVIES DWYN, PETERS NICHOLASS, BAKER VICTORIA, EARLEY MARKJ, SPORTON SIMON, DAVIES LCERI, WESTWOOD MARK, PETERSEN STEFFENE, SCHILLING RICHARDJ. Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Detection and Characterization of Left Atrial Catheter Ablation Lesions: A Multicenter Experience. J Cardiovasc Electrophysiol 2013; 24:396-403. [DOI: 10.1111/jce.12063] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Kolandaivelu A. Role of Cardiac Imaging (CT/MR) Before and After RF Catheter Ablation in Patients with Atrial Fibrillation. J Atr Fibrillation 2012; 5:523. [PMID: 28496759 DOI: 10.4022/jafib.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/29/2012] [Accepted: 05/11/2012] [Indexed: 01/08/2023]
Abstract
Pre-procedure X-ray computed tomography (CT) and magnetic resonance imaging (MRI) angiography are commonly used to delineate the complex and variable relationship of the left atrium, pulmonary veins, and surrounding structures. 3D CT and MR angiography are routinely incorporated into electroanatomic mapping systems to guide ablation lesion placement in the context of patient specific anatomy. Post-procedure CT and MRI have also proven useful for evaluating complications such as pulmonary vein stenosis. In the future, these imaging modalities may be used to visualize more detailed tissue characteristics such as atrial fibrosis and ablation lesions. This could improve selection of patients for different treatment strategies and perhaps guide more effective ablation. This review will discuss current and emerging applications of CT and MRI before and after radiofrequency catheter ablation of atrial fibrillation.
Collapse
Affiliation(s)
- Aravindan Kolandaivelu
- Johns Hopkins University School of Medicine, Division of Cardiology, Baltimore, MD 21205
| |
Collapse
|
45
|
Andrade JG, Khairy P, Verma A, Guerra PG, Dubuc M, Rivard L, Deyell MW, Mondesert B, Thibault B, Talajic M, Roy D, Macle L. Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:106-16. [PMID: 22054110 DOI: 10.1111/j.1540-8159.2011.03256.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The use of blanking periods, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. While ERAT can be expected to occur in approximately 38% of patients within the first 3 months of atrial fibrillation (AF) ablation, only half of these patients will manifest later recurrences. Clinical features related to the patient's history of AF, the index ablation procedure, and particularities of the ERAT can help identify patients at higher risk of later recurrence in whom aggressive attempts to control rhythm, including early cardioversion and reintervention, may be justified.
Collapse
Affiliation(s)
- Jason G Andrade
- Electrophysiology Service, Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Castrejón-Castrejón S, Ortega M, Pérez-Silva A, Doiny D, Estrada A, Filgueiras D, López-Sendón JL, Merino JL. Organized atrial tachycardias after atrial fibrillation ablation. Cardiol Res Pract 2011; 2011:957538. [PMID: 21941669 PMCID: PMC3175708 DOI: 10.4061/2011/957538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 04/17/2011] [Accepted: 05/17/2011] [Indexed: 11/20/2022] Open
Abstract
The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required.
Collapse
Affiliation(s)
- Sergio Castrejón-Castrejón
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, Paseo de la castellana, No 261, 28046 Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Tao Q, Milles J, VAN Huls VAN Taxis C, Lamb HJ, Reiber JHC, Zeppenfeld K, VAN DER Geest RJ. Toward magnetic resonance-guided electroanatomical voltage mapping for catheter ablation of scar-related ventricular tachycardia: a comparison of registration methods. J Cardiovasc Electrophysiol 2011; 23:74-80. [PMID: 21914023 DOI: 10.1111/j.1540-8167.2011.02167.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Integration of preprocedural delayed enhanced magnetic resonance imaging (DE-MRI) with electroanatomical voltage mapping (EAVM) may provide additional high-resolution substrate information for catheter ablation of scar-related ventricular tachycardias (VT). Accurate and fast image integration of DE-MRI with EAVM is desirable for MR-guided ablation. METHODS AND RESULTS Twenty-six VT patients with large transmural scar underwent catheter ablation and preprocedural DE-MRI. With different registration models and EAVM input, 3 image integration methods were evaluated and compared to the commercial registration module CartoMerge. The performance was evaluated both in terms of distance measure that describes surface matching, and correlation measure that describes actual scar correspondence. Compared to CartoMerge, the method that uses the translation-and-rotation model and high-density EAVM input resulted in a registration error of 4.32±0.69 mm as compared to 4.84 ± 1.07 (P <0.05); the method that uses the translation model and high-density EAVM input resulted in a registration error of 4.60 ± 0.65 mm (P = NS); and the method that uses the translation model and a single anatomical landmark input resulted in a registration error of 6.58 ± 1.63 mm (P < 0.05). No significant difference in scar correlation was observed between all 3 methods and CartoMerge (P = NS). CONCLUSIONS During VT ablation procedures, accurate integration of EAVM and DE-MRI can be achieved using a translation registration model and a single anatomical landmark. This model allows for image integration in minimal mapping time and is likely to reduce fluoroscopy time and increase procedure efficacy.
Collapse
Affiliation(s)
- Qian Tao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
48
|
Clinical Utility of Multimodality LA Imaging. JACC Cardiovasc Imaging 2011; 4:788-98. [DOI: 10.1016/j.jcmg.2011.02.018] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/28/2011] [Accepted: 02/15/2011] [Indexed: 11/23/2022]
|
49
|
Advances in imaging for atrial fibrillation ablation. Radiol Res Pract 2011; 2011:714864. [PMID: 22091384 PMCID: PMC3200077 DOI: 10.1155/2011/714864] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 12/30/2010] [Indexed: 01/13/2023] Open
Abstract
Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electroanatomic mapping systems, preprocedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electrophysiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment.
Collapse
|