Feasibility of late gadolinium enhancement magnetic resonance imaging to detect ablation lesion gaps in patients undergoing cryoballoon ablation of paroxysmal atrial fibrillation

Abstract

Background Although late gadolinium enhancement magnetic resonance imaging ( LGE ‐ MRI ) allows the identification of lesions and gaps after a cryothermal balloon ( CB ) ablation of paroxysmal atrial fibrillation ( PAF ), the accuracy has not yet been well established. Methods The subjects consisted of 10 consecutive patients who underwent a second ablation procedure among our cohort of 80 patients who underwent LGE ‐ MRI after the CB ablation of PAF . LGE ‐ MRI scar regions were compared with electroanatomical mapping during the second procedure. In the analysis, the unilateral pulmonary vein ( PV ) antrum was divided into 7 regions. Results The gap characterization analysis was performed in 140 regions around 40 PV s in total. There were 16 LGE ‐ MRI gaps around 11 PV s (mean 1.6 ± 1.4 gaps/patient) in 7 patients and 14 electrical gaps around 10 PV s in 8 patients (mean 1.4 ± 1.1 gaps/patient). The locations of 13 electrical gaps were well matched to that on the LGE ‐ MRI , whereas the remaining 1 electrical gap had not been predicted on the LGE ‐ MRI . Compared to the electrical gaps in the second procedure, the sensitivity and specificity of the LGE ‐ MRI gaps were 93% (13 LGE ‐ MRI gaps of 14 electrical gaps) and 98% (123 LGE ‐ MRI scars out of 126 electrical scars), respectively. Conclusion LGE ‐ MRI can accurately localize the lesion gaps after CB ablation of PAF .

Medical Image Analysis on Left Atrial LGE MRI for Atrial Fibrillation Studies: A Review

“…This may be due to the presence of a thicker myocardium in this area, which leads to non-transmural lesions (Galand et al, 2016). In (Bisbal et al, 2014;Mishima et al, 2019), the largest number of gaps occurred in right superior PV (RSPV) was reported; while in (Nuñez-Garcia et al, 2019) it was occurred in LSPV. In contrast, the fewest of gaps occurred consistently in the left inferior PV (LIPV) (Bisbal et al, 2014;Mishima et al, 2019;Nuñez-Garcia et al, 2019).…”

“…In (Bisbal et al, 2014;Mishima et al, 2019), the largest number of gaps occurred in right superior PV (RSPV) was reported; while in (Nuñez-Garcia et al, 2019) it was occurred in LSPV. In contrast, the fewest of gaps occurred consistently in the left inferior PV (LIPV) (Bisbal et al, 2014;Mishima et al, 2019;Nuñez-Garcia et al, 2019). The different distributions of gaps in different PV positions could be attributed to the differences of imaging and limited accuracy of scar segmentation of these regions.…”

“…LGE MRI has been recently widely explored for scar and ablation gap quantification (Nuñez-Garcia et al, 2019;Mishima et al, 2019). Note that T1-weighted MRI has become an imaging marker for diffused cardiac fibrosis, and has been validated against histological studies (Sibley et al, 2012).…”

“…Table 10 summarizes representative (semi-)automatic LA ablation gap quantification methods, results and main findings. Badger et al (2010) and Mishima et al (2019) both employed thresholding for scar segmentation, and then detected ablation gaps in visual. Ranjan et al (2012) and Harrison et al (2015a) both utilized software for gap quantification, i.e., Osirix and Custom-written software, respectively.…”

Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes?

“…Cardiac MRI studies have shown the regional lack of LGE to predict regions of reconnection during the second procedure after initial cryoablation with reasonable accuracy. 51 Mishima et al showed that, when LGE cardiac MRI was performed in patients with recurrent AF after initial ablation, regions without scar predicted accurately, in 93% of cases, where reconnections would be noted during EP study at the time of the second procedure. Other research suggests the sensitivity of cardiac MRI seems to be quite limited for gap identification after radiofrequency ablation 52 and its utility to be minimal following cryoablation.…”