3d Phase Sensitive Inversion Recovery in Cardiac Mri for Left Atrial Scar Assessment

Tomaiko, Emrie; Reichert, William M.; Bhagat, Abhishek; Zawaneh, Michael S.; Su, Wilber; Weiss, J. Peter; Unzek, Samuel; Morris, Michael

doi:10.1016/s0735-1097(22)02294-x

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“…Both CMR and CCT require administration of contrast to delineate areas of myocardial scar, which can be problematic in selected patients with impaired renal function [64]. Consensus on the ideal method for quantifying myocardial scar on CMR or CCT is lacking [65,66], with histologic data suggesting significant variability in the extent of myocardial scar and border zone areas depending on the methodology used for delineating fibrosis [67]. Lastly, volume changes and misalignment between CMR/CCTderived image mesh and EAM can lead to co-registration errors [68], limiting accuracy for the purpose targeting sites for ablation.…”

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confidence: 99%

Role of advanced imaging with cardiac computed tomography and MRI in atrial and ventricular ablation

Morris

Carlson

Bhagat³

2022

Current Opinion in Cardiology

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Purpose of reviewIncreasing evidence supports the use of advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) in the work-up of patients with arrythmias being considered for ablation.Recent findingsAdvances in imaging technology and postprocessing are facilitating the use of advanced imaging before, during and after ablation in patients with both atrial and ventricular arrhythmias.In atrial arrythmias, quantitative assessment of left atrial wall thickness on CCT and quantification of late gadolinium enhancement (LGE) on CMR identify patients more likely to develop recurrent atrial arrythmias following ablation. In addition, in patients with recurrent arrythmia post ablation, LGE CMR can potentially identify targets for repeat ablation.In ventricular arrythmias, qualitative assessment of LGE can aide in determining the optimal ablation approach and predicts likelihood of ventricular arrythmias inducibility. Quantitative assessment of LGE can identify conduction channels that can be targeted for ablation. On CCT, quantitative assessment of left ventricular wall thickness can demonstrate myocardial ridges associated with re-entrant circuits for ablation.SummaryThis review focuses on the utility of CCT and CMR in identifying key anatomical components and arrhythmogenic substrate contributing to both atrial and ventricular arrhythmias in patients being considered for ablation. Advanced imaging has the potential to improve procedural outcomes, decrease complications and shorten procedural time.

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