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Dong J, Kwan E, Bergquist JA, Steinberg BA, Dosdall DJ, DiBella EVR, MacLeod RS, Bunch TJ, Ranjan R. Ablation-induced left atrial mechanical dysfunction recovers in weeks after ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01795-x. [PMID: 38587576 DOI: 10.1007/s10840-024-01795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The immediate impact of catheter ablation on left atrial mechanical function and the timeline for its recovery in patients undergoing ablation for atrial fibrillation (AF) remain uncertain. The mechanical function response to catheter ablation in patients with different AF types is poorly understood. METHODS A total of 113 AF patients were included in this retrospective study. Each patient had three magnetic resonance imaging (MRI) studies in sinus rhythm: one pre-ablation, one immediate post-ablation (within 2 days after ablation), and one post-ablation follow-up MRI (≤ 3 months). We used feature tracking in the MRI cine images to determine peak longitudinal atrial strain (PLAS). We evaluated the change in strain from pre-ablation, immediately after ablation to post-ablation follow-up in a short-term study (< 50 days) and a 3-month study (3 months after ablation). RESULTS The PLAS exhibited a notable reduction immediately after ablation, compared to both pre-ablation levels and those observed in follow-up studies conducted at short-term (11.1 ± 9.0 days) and 3-month (69.6 ± 39.6 days) intervals. However, there was no difference between follow-up and pre-ablation PLAS. The PLAS returned to 95% pre-ablation level within 10 days. Paroxysmal AF patients had significantly higher pre-ablation PLAS than persistent AF patients in pre-ablation MRIs. Both type AF patients had significantly lower immediate post-ablation PLAS compared with pre-ablation and post-ablation PLAS. CONCLUSION The present study suggested a significant drop in PLAS immediately after ablation. Left atrial mechanical function recovered within 10 days after ablation. The drop in PLAS did not show a substantial difference between paroxysmal and persistent AF patients.
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Affiliation(s)
- Jiawei Dong
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eugene Kwan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jake A Bergquist
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Derek J Dosdall
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University fo Utah, Salt Lake City, UT, USA
| | - Edward V R DiBella
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rob S MacLeod
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ravi Ranjan
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
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Hopman LHGA, van Pouderoijen N, Mulder MJ, van der Laan AM, Bhagirath P, Nazarian S, Niessen HWM, Ferrari VA, Allaart CP, Götte MJW. Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance: Review of Imaging Strategies and Histological Correlations. JACC Clin Electrophysiol 2023; 9:2665-2679. [PMID: 37737780 DOI: 10.1016/j.jacep.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
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Affiliation(s)
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Saman Nazarian
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Victor A Ferrari
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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El Hajjar AH, Mekhael M, Huang C, Noujaim C, Zhang Y, Kholmovski E, Ayoub T, Lim CH, Marrouche N. Predictors of Lesions Contiguity and Transmurality in Canine Ventricular Models After Catheter Ablation. Front Cardiovasc Med 2022; 9:920539. [PMID: 35811729 PMCID: PMC9260253 DOI: 10.3389/fcvm.2022.920539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Interlesion gaps and transmurality of lesions after catheter ablation can precipitate suboptimal efficacy in preventing arrhythmias. Aims We aim to assess predictors of acute transmural lesion formation and the interlesion distance threshold for creating a continuous, chronic scar after ventricular ablation. Materials and Methods Ablation procedures were performed on 7 canines followed by late gadolinium enhancement MRI (LGE-MRI). Transmurality of lesions was assessed by 2 independent operators. Ablation parameters such as duration (s), power (W), temperature (C), contact force (CF) (g), were collected for each ablation point. After 7-12 weeks, LGE-MRI was performed, followed by euthanasia, and heart excision. Some lesions were created in pair. Lesion pairs were spaced 7-21 mm apart as measured by Electroanatomic mapping (EAM), with different operating parameters (power 35 or 50W, duration of energy delivery 10, 20 or 30s and contact force of 10g or above). We performed a logistic regression analysis to determine predictors of transmural lesion formation. Results Eighty-one radiofrequency ablation were performed in total [33 in the Left ventricle (LV) and 48 in the Right ventricle (RV)]. Higher CF was a significant predictor of transmural lesion formation (β = 0.15, OR = 1.16, 95% CI [1.03 – 1.3], p = 0.01), and lesions delivered in the RV were more frequently transmural than lesions delivered in the LV (β = −2.43, OR = 0.09, 95%CI [0.02 – 0.34], p < 0.001). For the paired analysis, thirty-eight lesions were created contiguously: fourteen connected lesions and twenty-four unconnected lesions. EAM distance was significantly larger in unconnected lesions than connected lesions (16.17 ± 0.92 mm vs. 11.51 ± 0.68 mm, respectively, p < 0.05). We concluded that an interlesion distance of less than 10 mm is required to prevent gap formation. Average volumes in unconnected lesions (n = 24) at the acute and chronic stages were 0.55 ± 0.11 cm3 and 0.20 ± 0.02 cm3, respectively. On average, lesion volumes were 64% (p < 0.05) smaller at the chronic stage compared to the acute stage. Among connected lesions (n = 14), we observed a volume of 1.19 ± 0.8 cm3 and 0.39 ± 0.15 cm3 at the acute and chronic stages, respectively. These connected lesions reduced in volume by 67% on average. Conclusion To create contiguous scars on the ventricular endocardial surface, paired lesions should be spaced less than ten millimeters apart. Higher contact force should be used in ventricular ablation to create transmural lesions.
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Affiliation(s)
- Abdel Hadi El Hajjar
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Mario Mekhael
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Chao Huang
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Charbel Noujaim
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Yichi Zhang
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Eugene Kholmovski
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Tarek Ayoub
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Chan Ho Lim
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
| | - Nassir Marrouche
- Department of Cardiology, Tulane Research Innovation for Arrhythmia Discoveries, Tulane University School of Medicine, New Orleans, LA, United States
- *Correspondence: Nassir Marrouche,
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Krahn PRP, Biswas L, Ferguson S, Ramanan V, Barry J, Singh SM, Pop M, Wright GA. MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. IEEE Trans Biomed Eng 2022; 69:2657-2666. [PMID: 35171765 DOI: 10.1109/tbme.2022.3152145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective: Radiofrequency (RF) energy delivered to cardiac tissue produces a core ablation lesion with surrounding edema, the latter of which has been implicated in acute procedural failure of Ventricular Tachycardia (VT) ablation and late arrhythmia recurrence. This study sought to investigate the electrophysiological characteristics of acute RF lesions in the left ventricle (LV) visualized with native-contrast Magnetic Resonance Imaging (MRI). Methods: An MR-guided electrophysiology system was used to deliver RF ablation in the LV of 8 swine (9 RF lesions in total), then perform MRI and electroanatomic mapping. The permanent RF lesions and transient edema were delineated via native-contrast MRI segmentation of T1-weighted images and T2 maps respectively. Bipolar voltage measurements were matched with image characteristics of pixels adjacent to the catheter tip. Native-contrast MR visualization was verified with 3D late gadolinium enhanced MRI and histology. Results: The T2-derived edema was significantly larger than the T1-derived RF lesion (2.11.5 mL compared to 0.580.34 mL; p=0.01). Bipolar voltage was significantly reduced in the presence of RF lesion core (p<0.05) and edema (p<0.05), with similar trends suggesting that both the permanent lesion and transient edema contributed to the region of reduced voltage. While bipolar voltage was significantly decreased where RF lesions are present (p<0.05), voltage did not change significantly with lesion transmurality (p>0.05). Conclusion: Permanent RF lesions and transient edema are distinct in native-contrast MR images, but not differentiable using bipolar voltage. Significance: Intraprocedural native-contrast MRI may provide valuable lesion assessment in MR-guided ablation, whose clinical application is now feasible.
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5
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Bauer BK, Meier C, Bietenbeck M, Lange PS, Eckardt L, Yilmaz A. Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation: Where Are We Now? JACC Clin Electrophysiol 2022; 8:261-274. [PMID: 35210090 DOI: 10.1016/j.jacep.2021.11.017] [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: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The possibilities of cardiovascular magnetic resonance (CMR) imaging for myocardial tissue characterization and catheter ablation guidance are accompanied by some fictional concepts. In this review, we present the available facts about CMR-guided catheter ablation procedures as well as promising, however unproven, theoretical concepts. CMR promises to visualize the respective arrhythmogenic substrate and may thereby make it more localizable for electrophysiology (EP)-based ablation. Robust CMR imaging is challenged by motion of the heart resulting from cardiac and respiratory cycles. In contrast to conventional "passive" tracking of the catheter tip by real-time CMR, novel approaches based on "active" tracking are performed by integrating microcoils into the catheter tip that send a receiver signal. Several experimental and clinical studies were already performed based on real-time CMR for catheter ablation of atrial and ventricular arrhythmias. Importantly, successful ablation of the cavotricuspid isthmus was already performed in patients with typical atrial flutter. However, a complete EP procedure with real-time CMR-guided transseptal puncture and subsequent pulmonary vein isolation has not been shown so far in patients with atrial fibrillation. Moreover, real-time CMR-guided EP for ventricular tachycardia ablation was only performed in animal models using a transseptal, retrograde, or epicardial access-but not in humans. Essential improvements within the next few years regarding basic technical requirements, such as higher spatial and temporal resolution of real-time CMR imaging as well as clinically approved cardiac magnetic resonance-conditional defibrillators, are ultimately required-but can also be expected-and will move this field forward.
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Affiliation(s)
- Bastian Klemens Bauer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany.
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6
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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7
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Nazer B, Giraud D, Zhao Y, Hodovan J, Elman MR, Masri A, Gerstenfeld EP, Lindner JR. High-intensity ultrasound catheter ablation achieves deep mid-myocardial lesions in vivo. Heart Rhythm 2020; 18:623-631. [PMID: 33385570 DOI: 10.1016/j.hrthm.2020.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation of epicardial and mid-myocardial ventricular arrhythmias is limited by lesion depth. OBJECTIVE The purpose of this study was to generate deep mid-interventricular septal (IVS) lesions using high-intensity ultrasound (US) from an endocardial catheter-based approach. METHODS Irrigated US catheters (12 F) were fabricated with 3 × 5 mm transducers of 5.0, 6.5, and 8.0 MHz frequencies and compared in an ex vivo perfused myocardial ablation model. In vivo septal ablation in swine (n = 12) was performed via femoral venous access to the right ventricle. Lesions were characterized by echocardiography, cardiac magnetic resonance imaging, and electroanatomic voltage mapping pre- and post-ablation, and at 30 days. Four animals were euthanized immediately post-ablation to compare acute and chronic lesion histology and gross pathology. RESULTS In ex vivo models, maximal lesion depth and volume was achieved by 6.5 MHz catheters, which were used in vivo. Lesion depth by gross pathology was similar post-ablation (10.8 mm; 95% confidence interval [CI] 9.9-12.4 mm) and at 30 days (11.2 mm; 95% CI 10.6-12.4 mm) (P = .56). Lesion volume decreased post-ablation to 30 days (from 255 [95% CI 198-440] to 162 [95% CI 133-234] mm3; P = .05), yet transmurality increased from 58% (95% CI 50%-76%) to 81% (95% CI 74%-93%), attributable to a reduction in IVS thickness (from 16.0 ± 1.7 to 10.6 ± 2.4 mm; P = .007). Magnetic resonance imaging confirmed dense septal ablation by delayed enhancement, with increased T1 time post-ablation and at 30 days and increased T2 time only post-ablation. Voltage mapping of both sides of IVS demonstrated reduced unipolar (but not bipolar) voltage along the IVS. CONCLUSION High-intensity US catheter ablation may be an effective treatment of mid-myocardial or epicardial ventricular arrhythmias from an endocardial approach.
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Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
| | - David Giraud
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Yan Zhao
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - James Hodovan
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Miriam R Elman
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; School of Public Health, OHSU/Portland State University, Portland, Oregon
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Edward P Gerstenfeld
- Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
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8
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Habibi M, Lima JAC, Gucuk Ipek E, Spragg D, Ashikaga H, Marine JE, Berger RD, Calkins H, Nazarian S. Short- and long-term associations of atrial fibrillation catheter ablation with left atrial structure and function: A cardiac magnetic resonance study. J Cardiovasc Electrophysiol 2020; 32:316-324. [PMID: 33350536 DOI: 10.1111/jce.14842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effects of atrial fibrillation (AF) catheter ablation on the left atrium (LA) are poorly understood. OBJECTIVES To examine short- and long-term associations of AF catheter ablation with LA function using cardiac magnetic resonance (CMR). METHODS Fifty-one AF patients (mean age 56 ± 8 years) underwent CMR at baseline, 1 day (n = 17) and 11 ± 2 months after ablation (n = 38). LA phasic volumes, emptying fractions (LAEF), and longitudinal strain were measured using feature-tracking CMR. LA fibrosis was quantified using late gadolinium enhancement (LGE). RESULTS There were no acute changes in volume; however, active, total LAEF, and peak LA strain decreased significantly compared to the baseline. During long-term follow-up, there was a decrease in maximum but not minimum LA volume (from 99 ± 5.2 ml to 89 ± 4.7 ml; p = .009) and a decrease in total LAEF (from 43 ± 1.8% to 39 ± 2.0%; p = .001). In patients with AF recurrence, LA volumes were unchanged. However, total LAEF decreased from 38 ± 3% to 33 ± 3%; p = .015. Patients without AF recurrence had no changes in LA functional parameters during follow-up. The amount of LA LGE at long-term follow-up was higher compared to the baseline, however, was significantly less compared to immediately post-procedure (37 ± 1.9% vs. 47 ± 2.8%; p = .015). A higher increase in LA LGE extent compared to the baseline was associated with a greater decrease in total LAEF (r = -.59; p < .001). CONCLUSIONS LA function is impaired acutely following AF catheter ablation. However, long-term changes of LA function are associated positively with the successful restoration of sinus rhythm and inversely with increased LA LGE.
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Affiliation(s)
- Mohammadali Habibi
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Valley Health System and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey, USA
| | - Joao A C Lima
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esra Gucuk Ipek
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Spragg
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hiroshi Ashikaga
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph E Marine
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald D Berger
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saman Nazarian
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Cardiology, Section for Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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9
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Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T. Black-Blood Contrast in Cardiovascular MRI. J Magn Reson Imaging 2020; 55:61-80. [PMID: 33078512 PMCID: PMC9292502 DOI: 10.1002/jmri.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds.
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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, UK
| | - Shaihan Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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10
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Guttman MA, Tao S, Fink S, Tunin R, Schmidt EJ, Herzka DA, Halperin HR, Kolandaivelu A. Acute enhancement of necrotic radio-frequency ablation lesions in left atrium and pulmonary vein ostia in swine model with non-contrast-enhanced T 1 -weighted MRI. Magn Reson Med 2020; 83:1368-1379. [PMID: 31565818 PMCID: PMC6949368 DOI: 10.1002/mrm.28001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate non-contrast-enhanced MRI of acute radio-frequency ablation (RFA) lesions in the left atrium (LA) and pulmonary vein (PV) ostia. The goal is to provide a method for discrimination between necrotic (permanent) lesions and reversible injury, which is associated with recurrence after treatment of atrial fibrillation. METHODS Fifteen normal swine underwent RFA around the right-superior PV ostia. Electrical pulmonary vein isolation (PVI) was verified by electro-anatomic mapping (EAM) and pacing. MRI was carried out using a 3D respiratory-gated T1 -weighted long inversion time (TWILITE) sequence without contrast agent. Key settings were: inversion time 700 ms, triggering over 2 cardiac cycles, pixel size 1.1 mm3 . Contrast-enhanced imaging and T2 -weighted imaging were carried out for comparison. Six animals were sacrificed on ablation day for TTC-stained gross pathology, 9 animals were sacrificed after 2-3 mo after repeat EAM and MRI. Image intensity ratio (IIR) was used to measure lesion enhancement, and gross pathology was used to validate image enhancement patterns and compare lesion widths. RESULTS RFA lesions exhibited unambiguous enhancement in acute TWILITE imaging (IIR = 2.34 ± 0.49 at 1.5T), and the enhancement patterns corresponded well with gross pathology. Lesion widths in MRI correlated well with gross pathology (R2 = 0.84), with slight underestimation by 0.9 ± 0.5 mm. Lesion enhancement subsided chronically. CONCLUSION TWILITE imaging allowed acute detection of permanent RFA lesions in swine LA and PV ostia, without the need for contrast agent. Lesion enhancement pattern showed good correspondence to gross pathology and was well visualized by volume rendering. This method may provide valuable intra- or post-procedural assessment of RFA treatment.
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Affiliation(s)
- Michael A Guttman
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susumu Tao
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Fink
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rick Tunin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ehud J Schmidt
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry R Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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11
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Yamashita K, Ghafoori E, Silvernagel J, Ashton J, J Dosdall D, MacLeod R, Ranjan R. The Effective Contact Force to Minimize Edema Relative to Chronic Lesion Formation During Radiofrequency Ablation in Ventricular Wall. Int Heart J 2019; 60:1407-1414. [PMID: 31735778 DOI: 10.1536/ihj.19-128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Radiofrequency (RF) ablation results in creation of acute edema which can lead to temporary disruption of electrical propagation.The goal of this study was to find the effective contact force (CF) to minimize edema formation in comparison to the lesion size.Ventricular RF lesions (n = 49) were created by a CF-sensing catheter in a canine model (n = 10) with varying force for 30 seconds. Animals underwent T2-weighted (T2w) and late gadolinium enhancement MRI (LGE-MRI) immediately after ablation and at 12 weeks. Acute LGE lesion volume, acute edema, and chronic LGE lesion volume were measured. Acute edema/acute LGE lesion volume ratio was used to divide the lesions into two groups.Mean edema/lesion volume ratio was 5.0 ± 2.8. The lesions were divided into greater edema group (n = 8) and smaller edema group (n = 41) based on a cutoff edema/lesion volume ratio. When comparing the two groups, the CF and force time integral (FTI) were significantly lower in the greater edema group. There was no difference in catheter power setting, tip temperature change, impedance drop, and bipolar electrogram voltage change. Acute LGE volume and chronic lesion depth were significantly smaller in the greater edema group. Moreover, receiver-operator characteristic curve for the smaller edema lesion group showed that the most discriminant cutoff values for CF and FTI were 12.4 g and 584 gs, respectively.To minimize edema size while still forming permanent lesions, ablation should be performed with FTI > 584 gs or CF > 12.4 g.
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Affiliation(s)
- Kennosuke Yamashita
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison CVRTI, University of Utah
| | - Elyar Ghafoori
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | - Josh Silvernagel
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | | | - Derek J Dosdall
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
- Division of Cardiothoracic Surgery, University of Utah
| | - Robert MacLeod
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison CVRTI, University of Utah
- Department of Bioengineering, University of Utah
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12
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Catheter Ablation in Scar: A Journey Into the Unknown. JACC Clin Electrophysiol 2019; 5:932-934. [PMID: 31439294 DOI: 10.1016/j.jacep.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/21/2022]
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13
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Okada DR, Wu KC. Applications of Cardiac MR Imaging in Electrophysiology. Magn Reson Imaging Clin N Am 2019; 27:465-473. [PMID: 31279450 DOI: 10.1016/j.mric.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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14
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Barkagan M, Leshem E, Shapira-Daniels A, Sroubek J, Buxton AE, Saffitz JE, Anter E. Histopathological Characterization of Radiofrequency Ablation in Ventricular Scar Tissue. JACC Clin Electrophysiol 2019; 5:920-931. [PMID: 31439293 DOI: 10.1016/j.jacep.2019.05.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to characterize the histopathological features of radiofrequency ablation (RFA) in heterogeneous ventricular scar in comparison to those in healthy myocardium. BACKGROUND The histopathological features of RFA have been studied largely in normal myocardium. However, its effect on clinically relevant heterogeneous scar is not well understood. METHODS Five swine with chronic infarction underwent RFA using 35-W, 45-s, 10-20 g (Biosense Webster, Irwindale, California) in heterogenous scar tissue (voltage ≤1.5 mV) and healthy myocardium (≥3.0 mV). The location of each application was marked using the electroanatomical mapping system. Histological sections at intervals of 0.5 mm with hematoxylin and eosin and Masson's trichrome stained intervals were created. A pathologist blinded to the myocardium type characterized the extent of RF injury in cellular, extracellular, and vascular structures. RESULTS In healthy myocardium, 23 of 23 lesions (100%) were well demarcated and could be precisely measured (width: 11.3 ± 3.3 mm; depth: 7.3 ± 2.0 mm). In scar tissue, only 3 of 30 lesions (10%) were identified, and none could be measured due to a lack of defined borders. Lesions in healthy myocardium had a distinctive architecture showing a coagulative necrosis core surrounded by an outer rim of contraction band necrosis. Lesions in scar had ill-defined tissue injury without a distinct architecture. In all ablated regions, viable myocytes remained interspersed between necrotic myocytes exhibiting characteristics of both coagulative and contraction band necrosis. Connective tissue was more resistant to thermal injury in comparison to cardiomyocytes. CONCLUSIONS RFA in scarred myocardium results in irregular tissue injury and unpredictable effect on surviving cardiomyocytes. This may be related to biophysical differences between healthy and scarred myocardium.
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Affiliation(s)
- Michael Barkagan
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eran Leshem
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ayelet Shapira-Daniels
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jakub Sroubek
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alfred E Buxton
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Elad Anter
- Division of Cardiovascular Medicine, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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15
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Mukherjee RK, Chubb H, Roujol S, Razavi R, O'Neill MD. Advances in Real-Time MRI-Guided Electrophysiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12:6. [PMID: 31501689 PMCID: PMC6733706 DOI: 10.1007/s12410-019-9481-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose of Review Theoretical benefits of real-time MRI guidance over conventional electrophysiology include contemporaneous 3D substrate assessment and accurate intra-procedural guidance and evaluation of ablation lesions. We review the unique challenges inherent to MRI-guided electrophysiology and how to translate the potential benefits in the treatment of cardiac arrhythmias. Recent Findings Over the last 5 years, there has been substantial progress, initially in animal models and more recently in clinical studies, to establish methods and develop workflows within the MR environment that resemble those of conventional electrophysiology laboratories. Real-time MRI-guided systems have been used to perform electroanatomic mapping and ablation in patients with atrial flutter, and there is interest in developing the technology to tackle more complex arrhythmias including atrial fibrillation and ventricular tachycardia. Summary Mainstream adoption of real-time MRI-guided electrophysiology will require demonstration of clinical benefit and will be aided by increased availability of devices suitable for use in the MRI environment.
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Affiliation(s)
- Rahul K Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK
| | - Mark D O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK.,Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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16
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Wright GA, Krahn PRP, Glover BM. Magnetic Resonance Imaging: A New Gold Standard for Radiofrequency Ablation Assessment in Ventricular Arrhythmia Treatments? JACC Clin Electrophysiol 2019; 5:101-103. [PMID: 30678773 DOI: 10.1016/j.jacep.2018.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Graham A Wright
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Philippa R P Krahn
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benedict M Glover
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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