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Guglielmo M, Rier S, Zan GD, Krafft AJ, Schmidt M, Kunze KP, Botnar RM, Prieto C, van der Heijden J, Van Driel V, Ramanna H, van der Harst P, van der Bilt I. Cardiac magnetic resonance for early atrial lesion visualization post atrial fibrillation radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2024; 35:258-266. [PMID: 38065834 DOI: 10.1111/jce.16152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Incomplete atrial lesions resulting in pulmonary vein-left atrium reconnection after pulmonary vein antrum isolation (PVAI), are related to atrial fibrillation (AF) recurrence. Unfortunately, during the PVAI procedure, fluoroscopy and electroanatomic mapping cannot accurately determine the location and size of the ablation lesions in the atrial wall and this can result in incomplete PVAI lesions (PVAI-L) after radiofrequency catheter ablation (RFCA). AIM We seek to evaluate whether cardiac magnetic resonance (CMR), immediately after RFCA of AF, can identify PVAI-L by characterizing the left atrial tissue. METHODS Ten patients (63.1 ± 5.7 years old, 80% male) receiving a RFCA for paroxysmal AF underwent a CMR before (<1 week) and after (<1 h) the PVAI. Two-dimensional dark-blood T2-weighted short tau inversion recovery (DB-STIR), Three-dimensional inversion-recovery prepared long inversion time (3D-TWILITE) and three-dimensional late gadolinium enhancement (3D-LGE) images were performed to visualize PVAI-L. RESULTS The PVAI-L was visible in 10 patients (100%) using 3D-TWILITE and 3D-LGE. Conversely, On DB-STIR, the ablation core of the PAVI-L could not be identified because of a diffuse high signal of the atrial wall post-PVAI. Microvascular obstruction was identified in 7 (70%) patients using 3D-LGE. CONCLUSION CMR can visualize PVAI-L immediately after the RFCA of AF even without the use of contrast agents. Future studies are needed to understand if the use of CMR for PVAI-L detection after RFCA can improve the results of ablation procedures.
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Affiliation(s)
- Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sophie Rier
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Giulia De Zan
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | | | - Karl P Kunze
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Rene M Botnar
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | - Claudia Prieto
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
- King's College London, London, UK
| | | | - Vincent Van Driel
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
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2
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Roca-Luque I, Vázquez-Calvo S, Garre P, Ortiz-Perez JT, Prat-Gonzalez S, Sanchez-Somonte P, Ferro E, Quinto L, Alarcón F, Althoff T, Perea RJ, Figueras i Ventura RM, Guasch E, Tolosana JM, Lorenzatti D, Morr-Verenzuela CI, Porta-Sanchez A, Arbelo E, Sitges M, Brugada J, Mont L. Post-Ablation cardiac Magnetic resonance to assess Ventricular Tachycardia recurrence (PAM-VT study). Eur Heart J Cardiovasc Imaging 2024; 25:188-198. [PMID: 37819047 PMCID: PMC10824475 DOI: 10.1093/ehjci/jead261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Conducting channels (CCs) detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related to ventricular tachycardia (VT). The aim of this work was to study the ability of post-ablation LGE-CMR to evaluate ablation lesions. METHODS AND RESULTS This is a prospective study of consecutive patients referred for a scar-related VT ablation. LGE-CMR was performed 6-12 months prior to ablation and 3-6 months after ablation. Scar characteristics of pre- and post-ablation LGE-CMR were compared. During the study period (March 2019-April 2021), 61 consecutive patients underwent scar-related VT ablation after LGE-CMR. Overall, 12 patients were excluded (4 had poor-quality LGE-CMR, 2 died before post-ablation LGE-CMR, and 6 underwent post-ablation LGE-CMR 12 months after ablation). Finally, 49 patients (age: 65.5 ± 9.8 years, 97.9% male, left ventricular ejection fraction: 34.8 ± 10.4%, 87.7% ischaemic cardiomyopathy) were included. Post-ablation LGE-CMR showed a decrease in the number (3.34 ± 1.03 vs. 1.6 ± 0.2; P < 0.0001) and mass (8.45 ± 1.3 vs. 3.5 ± 0.6 g; P < 0.001) of CCs. Arrhythmogenic CCs disappeared in 74.4% of patients. Dark core was detected in 75.5% of patients, and its presence was not related to CC reduction (52.2 ± 7.4% vs. 40.8 ± 10.6%, P = 0.57). VT recurrence after one year follow-up was 16.3%. The presence of two or more channels in the post-ablation LGE-CMR was a predictor of VT recurrence (31.82% vs. 0%, P = 0.0038) with a sensibility of 100% and specificity of 61% (area under the curve 0.82). In the same line, a reduction of CCs < 55% had sensibility of 100% and specificity of 61% (area under the curve 0.83) to predict VT recurrence. CONCLUSION Post-ablation LGE-CMR is feasible, and a reduction in the number of CCs is related with lower risk of VT recurrence. The dark core was not present in all patients. A decrease in VT substrate was also observed in patients without a dark core area in the post-ablation LGE-CMR.
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Affiliation(s)
- Ivo Roca-Luque
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sara Vázquez-Calvo
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paz Garre
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jose T Ortiz-Perez
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Susanna Prat-Gonzalez
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paula Sanchez-Somonte
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Elisenda Ferro
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Levio Quinto
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Till Althoff
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rosario Jesús Perea
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | | | - Eduard Guasch
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Lorenzatti
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Carlos Igor Morr-Verenzuela
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Andreu Porta-Sanchez
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Sitges
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Brugada
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Arrhyhtmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel st. 170, Catalonia, 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 PMCID: PMC11211236 DOI: 10.1016/j.jocmr.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
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Ghannam M, Bogun F. Improving Outcomes in Ventricular Tachycardia Ablation Using Imaging to Identify Arrhythmic Substrates. Card Electrophysiol Clin 2022; 14:609-620. [PMID: 36396180 DOI: 10.1016/j.ccep.2022.06.009] [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] [Indexed: 06/16/2023]
Abstract
Ventricular tachycardia (VT) ablation is limited by modest acute and long-term success rates, in part due to the challenges in accurately identifying the arrhythmogenic substrate. The combination of multimodality imaging along with information from electroanatomic mapping allows for a more comprehensive assessment of the arrhythmogenic substrate which facilitates VT ablation, and the use of preprocedural imaging has been shown to improve long-term ablation outcomes. Beyond regional recognition of the arrhythmogenic substrate, advanced imaging techniques can be used to create tailored ablation strategies preprocedurally. This review will focus on how imaging can be used to guide ablation planning and execution with a focus on clinical applications aimed at improving the outcome of VT ablation procedures.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC5853, Ann Arbor, Michigan 48109-5853, USA.
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, 1500 E. Medical Center Dr., SPC5853, Ann Arbor, Michigan 48109-5853, USA
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5
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Ghannam M, Liang J, Attili A, Cochet H, Jais P, Latchamsetty R, Jongnarangsin K, Morady F, Gordon D, Bogun F. Magnetic Resonance Imaging and Histopathology of Catheter Ablation Lesions after Ventricular Tachycardia Ablation in Patients with Nonischemic Cardiomyopathy. Heart Rhythm 2022; 19:1642-1649. [PMID: 35772697 DOI: 10.1016/j.hrthm.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) imaging may help identify radiofrequency ablation lesions. This has been poorly described in patients with non-ischemic cardiomyopathy (NICM). OBJECTIVES To describe LGE-CMR characteristics of ablation lesions in patients with NICM and correlate with histopathology. METHODS Twenty-six patients (24 males, 38±14 ejection fraction, 61±9 age), with CMR imaging after VT ablation were included. Areas of both dark and bright core lesions correlating with prior radiofrequency ablation lesions were identified. Histology was performed on an explanted heart. RESULTS The mean time between the ablation procedure and the LGE-CMR study was 8[2-20] months. Twenty-three/26 patients demonstrated dark-core lesions (volume 2.16±1.8 cm3, thickness 3.6±1.3 mm) with a transmurality of 42±16%, overlaying areas of intramural or transmural LGE. Fourteen/26 patients demonstrated bright core lesions (volume 0.8±0.6 cm3, depth 4.15±1.76 mm) with a transmurality of 34±14%, which was located in areas without underlying LGE in 11/13 patients. Both dark and bright core lesions were visualized on standard clinical LGE-CMR imaging obtained in the acute setting and chronic settings (within 3 days and up to 2090 days post ablation). Histopathologic analysis demonstrated coagulation necrosis in the area that corresponded to dark core lesions in the post ablation CMR. CONCLUSION Ablation lesions can be detected by LGE-CMR after VT ablation in NICM patients and have a different appearance than scar tissue. These lesions can be observed in the acute and chronic settings after ablations.
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Affiliation(s)
| | | | | | - Hubert Cochet
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | - Pierre Jais
- Bordeaux University Hospital and University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France
| | | | | | | | - David Gordon
- Department of Pathology University of Michigan, Ann Arbor, MI, USA
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Mont L, Roca-Luque I, Althoff TF. Ablation Lesion Assessment with MRI. Arrhythm Electrophysiol Rev 2022; 11:e02. [PMID: 35444808 PMCID: PMC9014705 DOI: 10.15420/aer.2021.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.
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Affiliation(s)
- Lluís Mont
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute, Clínic - University Hospital Barcelona Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Department of Cardiology and Angiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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7
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Pype LL, Holtackers RJ, Paelinck BP, Bekelaar T, Heidbuchel H, Van De Heyning CM. Persistent microvascular obstruction-like lesion after ventricular tachycardia ablation detected by novel dark-blood late gadolinium enhancement. BJR Case Rep 2022; 8:20210124. [PMID: 36101728 PMCID: PMC9461736 DOI: 10.1259/bjrcr.20210124] [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: 06/25/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 12/02/2022] Open
Abstract
Microvascular obstruction is a transient phenomenon of “no reflow” after myocardial infarction or radiofrequency ablation, diagnosed using late gadolinium enhancement cardiac MRI. We present a patient with a persistent microvascular obstruction-like lesion following radiofrequency ventricular tachycardia ablation post-myocardial infarction, which was best characterized by a novel dark-blood late gadolinium enhancement technique.
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Affiliation(s)
- Lobke L Pype
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Robert J Holtackers
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre P. Debyelaan, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Duboisdomein, Maastricht, the Netherlands
| | - Bernard P Paelinck
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
- Department of Cardiac Surgery, Antwerp University Hospital, Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Thalia Bekelaar
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
| | - Caroline M Van De Heyning
- Department of Cardiology, Antwerp University Hospital Drie Eikenstraat, Antwerp (Edegem), Belgium
- Research group Cardiovascular Diseases, GENCOR, Antwerp University Universiteitsplein, Antwerp, Belgium
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Nakamura K, Sasaki T, Koyama K, Naito S. A confluent non-enhanced dark core on serial late gadolinium enhancement imaging after a moderator band-ventricular tachycardia ablation. Indian Pacing Electrophysiol J 2022; 22:154-157. [PMID: 35134485 PMCID: PMC9091750 DOI: 10.1016/j.ipej.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 10/26/2022] Open
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Chronic Ablation Lesions on CMR: Is Black a Red Herring? JACC Cardiovasc Imaging 2020; 14:599-601. [PMID: 33248955 DOI: 10.1016/j.jcmg.2020.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/21/2022]
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Brett CL, Cook JA, Aboud AA, Karim R, Shinohara ET, Stevenson WG. Novel Workflow for Conversion of Catheter-Based Electroanatomic Mapping to DICOM Imaging for Noninvasive Radioablation of Ventricular Tachycardia. Pract Radiat Oncol 2020; 11:84-88. [PMID: 32416269 DOI: 10.1016/j.prro.2020.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/06/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE A recent clinical trial has demonstrated that noninvasive radioablation (NIRA) has the potential to reduce recurrent ventricular tachycardia (VT) that is refractory to drugs and standard catheter ablation. Electroanatomic mapping (EAM) that would be useful for planning is obtained during catheter ablation, but incompatibility between EAM and DICOM formats required for radiation planning has impeded the use of existing catheter-based mapping to guide NIRA and is an important hurdle for its wider adoption. In this paper we define a process to facilitate the fusion of catheter-based EAM with DICOM imaging for radiation planning. METHOD AND MATERIALS The raw data export of the CARTO3 EAM system (version 6.0.45.171, ".mesh" file) was processed with a MATLAB script to generate 3-dimensional (3D) visual took kit files containing X, Y, Z coordinates obtained during mapping and corresponding impedance, voltage, and other point-based information. The image could then be visualized with standard image processing software (3D Slicer) and the target outlined on the image surface. This structure was in turn converted to a DICOM image and fused with patient thoracic imaging using anatomic landmarks. Robustness of the workflow was assessed through implementation with a second magnetic resonance imaging based VT ablation planning system, ADAS-VT. RESULTS This process facilitated the fusion of EAM and DICOM imaging to inform selection of NIRA targets. The workflow was found to be robust and compatible with a second VT ablation planning system. CONCLUSIONS The conversion of catheter-based EAM to a DICOM compatible format permits the fusion of images for radiation planning and provides an avenue for the wider application of NIRA. Further improvements in the compatibility of these imaging formats would be expected to improve quality and reproducibility of image fusion.
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Affiliation(s)
- Christopher L Brett
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jason A Cook
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Asad A Aboud
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rashed Karim
- National Heart & Lung Institute, Imperial College of London, United Kingdom
| | - Eric T Shinohara
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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