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Lindemann F, Oebel S, Paetsch I, Arya A, Dagres N, Richter S, Dinov B, Hilbert S, Loebe S, Stegmann C, Doering M, Bollmann A, Hindricks G, Jahnke C. Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms. J Cardiovasc Magn Reson 2020; 22:32. [PMID: 32389126 PMCID: PMC7212569 DOI: 10.1186/s12968-020-00609-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).
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Affiliation(s)
- Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Susanne Loebe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Clara Stegmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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Paetsch I, Sommer P, Jahnke C, Hilbert S, Loebe S, Schoene K, Oebel S, Krueger S, Weiss S, Smink J, Lloyd T, Hindricks G. Clinical workflow and applicability of electrophysiological cardiovascular magnetic resonance-guided radiofrequency ablation of isthmus-dependent atrial flutter. Eur Heart J Cardiovasc Imaging 2019; 20:147-156. [PMID: 30307544 DOI: 10.1093/ehjci/jey143] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
Aims To determine safety and efficacy of electrophysiological cardiovascular magnetic resonance (EP-CMR)-guided radiofrequency (RF) ablation in patients with typical right atrial flutter in a routine clinical setting. Methods and results Thirty patients with typical right atrial flutter underwent clinically indicated EP-CMR-guided cavotricuspid isthmus ablation. EP-CMR protocols included pre- and post-ablation CMR imaging (whole heart, T2-weighted, and early-/late-gadolinium enhancement) together with electroanatomic mapping of the right atrium. Coronary sinus cannulation time and total ablation procedure duration were used as performance measures to determine the learning experience of the EP-CMR interventionalist and for comparison with conventional, fluoroscopy-guided atrial flutter ablation. Procedural safety and success rates were evaluated at 1 week and 3 months follow-up. Safety and success rates of EP-CMR were similar to conventional flutter ablations (primary success rate, 93% vs. 100%; recurrence rate, 0% vs. 3%, respectively). EP-CMR procedure duration indicated a learning experience (first vs. last six patients, 54.2 ± 23.1 vs. 29.7 ± 20.0 min) and the minimum number of procedures needed to achieve a level of competency was n = 12. An isthmus angle <110° and the presence of pouch-like isthmus anatomy were indicative of significantly prolonged EP-CMR procedure duration. CMR-defined ablation lesion size was not associated with total RF-ablation time or RF-induced maximum temperature. Conclusion In a routine clinical setting, EP-CMR demonstrated its safety and high efficacy for the treatment of typical right atrial flutter with performance and outcome measures similar to conventional, fluoroscopy-guided flutter ablation. Hence, EP-CMR represents a valid alternative to conventional right atrial flutter ablation.
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Affiliation(s)
- Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Susanne Loebe
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Katharina Schoene
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Sascha Krueger
- Philips Research Laboratories, Veenpluis 6, 5684 PC Best, The Netherlands and Roentgenstrasse 24-26, Hamburg, Germany
| | - Steffen Weiss
- Philips Research Laboratories, Veenpluis 6, 5684 PC Best, The Netherlands and Roentgenstrasse 24-26, Hamburg, Germany
| | - Jouke Smink
- Philips Research Laboratories, Veenpluis 6, 5684 PC Best, The Netherlands and Roentgenstrasse 24-26, Hamburg, Germany
| | - Tom Lloyd
- Imricor Medical Systems, 400 Gateway Blvd., Burnsville, MN, USA
| | - Gerhard Hindricks
- Department of Electrophysiology, HELIOS Heart Center, University of Leipzig, Struempellstr. 39, Leipzig, Germany
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Dinov B, Oebel S, Hilbert S, Loebe S, Arya A, Bollmann A, Sommer P, Jahnke C, Paetsch I, Hindricks G. Characteristics of the ablation lesions in cardiac magnetic resonance imaging after radiofrequency ablation of ventricular arrhythmias in relation to the procedural success. Am Heart J 2018; 204:68-75. [PMID: 30077835 DOI: 10.1016/j.ahj.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In human patients, studies about the cardiac magnetic resonance (CMR) appearance of the acute radiofrequency (RF) lesions in relation to the procedural outcomes after catheter ablation (CA) of ventricular arrhythmias (VA) are scarce. We aimed to investigate the RF lesions characteristics in relation to the procedural success. METHODS Patients referred for ablation of VA received CMR (1.5 T) using gadolinium contrast before and after ablation. CA in left ventricle was performed using a 3.5-mm irrigated catheter. The volume and transmurality of the RF-induced lesions were measured in early gadolinium-enhanced postablation CMRs. Acute failure was defined as persistently inducible VA at the end of the CA. RESULTS Twenty-five patients (60.7 ± 9.8 years, 19 with sustained ventricular tachycardia) were studied. All RF lesions had nonenhanced core. The volume of the nonenhanced lesions showed positive correlation with the maximal RF power (r = 0.598, P = .002) and the impedance drop (r = 0.416, P = .038). Patients with transmural (≥75%) lesions had significantly larger impedance drop as compared to those with nontransmural lesions (<75%): 20.3 ± 9.4 versus 13.5 ± 4.3, P = .037. In the failures, the lesions volume was nonsignificantly larger: 3.86 ± 3.3% versus 2.6 ± 1.7%, P = .197; however, it was considerably deeper: 86 ± 13% versus 62 ± 26%, P = .03. CONCLUSIONS CMR after VA ablation showed nonenhanced lesions resembling the no-reflow phenomenon in myocardial infarction. Although the size and the depth of the RF injury correlated with the ablation energy and impedance drop, they were not associated with acute ablation success.
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Seewoester T, Hilbert S, Hindricks G, Bollmann A, Loebe S, Richter S, Doering M, Paetsch I, Jahnke C. P926Cardiac Device safety and risks in Patients undergoing Cardiac MRI: Current Strategies and Results from 200 Patients. Europace 2018. [DOI: 10.1093/europace/euy015.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Seewoester
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Hilbert
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - G Hindricks
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - A Bollmann
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Loebe
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - S Richter
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - M Doering
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - I Paetsch
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
| | - C Jahnke
- Heart Center of Leipzig, Rhythmology, Leipzig, Germany
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Hilbert S, Jahnke C, Loebe S, Oebel S, Weber A, Spampinato R, Richter S, Doering M, Bollmann A, Sommer P, Hindricks G, Paetsch I. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality. Eur Heart J Cardiovasc Imaging 2017; 19:1051-1061. [DOI: 10.1093/ehjci/jex243] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/23/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Hilbert
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Cosima Jahnke
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Susanne Loebe
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sabrina Oebel
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Alexander Weber
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ricardo Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sergio Richter
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Michael Doering
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ingo Paetsch
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
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Loebe S, Hilbert S, Weber A, Rogge C, Oebel S, Spampinato R, Richter S, Doering M, Sommer P, Hindricks G, Paetsch I, Jahnke C. 4099Cardiovascular magnetic resonance imaging in cardiac device carriers: assessment of right-ventricular function and scar. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Loebe S, Salmas J, John S, Kornej J, Husser D, Hindricks G, Bollmann A. Discontinuation of dronedarone treatment for atrial arrhythmias - incidence, timing and causes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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