Late Gadolinium Enhancement Mri as a Novel Screening Modality for Esophageal Thermal Injury After Atrial Fibrillation Ablation

Marashly, Qussay; Gopinath, Chaitra; Baher, Alex; Acharya, Madan; Aljuaid, Mossab; Kheirkhahan, Mobin; Marrouche, Nassir F.; Chelu, Mihail G.

doi:10.1016/s0735-1097(20)30904-9

Cited by 1 publication

(3 citation statements)

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“…Only one patient had moderate enhancement without ETI on EGD. As seen before, pathological imaging commonly appeared in the acute postablation period with almost all cases exhibiting complete resolution within 3 months 6,33 . It seems possible that acute enhancement dissolving within 1 to 3 days, indicates transient procedure‐related inflammatory response with edema rather than clinically relevant esophageal tissue necrosis leading to severe complications.…”

Section: Discussionmentioning

confidence: 77%

“…In a recent analysis, only moderate and severe esophageal enhancement exhibited high sensitivity and negative predictive value (100% each, 78% specificity) for the detection of ETI confirmed by EGD 33 . Especially the combination of lasting symptoms and persistent esophageal enhancement of the anterior wall without posterior wall involvement beyond 24‐hour postablation were associated with esophageal ulcer 32 .…”

Section: Discussionmentioning

confidence: 97%

“…LGE‐MRI has been reported a useful screening modality for early detection and further monitoring of ETI 6 . Esophageal enhancement immediately after ablation is frequently observed in 50 to 80% of cases but did not predict severe ETI on EGD at such an early stage 31‐33 …”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance imaging–guided cryoballoon ablation for left atrial substrate modification in patients with atrial fibrillation

Kirstein

Morris

Baher

et al. 2020

Cardiovasc electrophysiol

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Background Cryoballoon ablation (CBA) for pulmonary vein isolation (PVI) is an established modality for the treatment of atrial fibrillation (AF). We report feasibility of left atrial (LA) substrate modification in addition to PVI both using the cryoballoon. Methods LA substrates and CBA‐induced scar were assessed at baseline and 3 months after ablation using late gadolinium enhancement magnetic resonance imaging (LGE‐MRI). Common periprocedural data including postablation LGE‐MRI for evaluation of esophageal thermal injury, and CBA‐associated complications were collected. Freedom from AF recurrence at 12 months was assessed using Holter and 30‐day rhythm monitors. Results In 26 patients (64 ± 11 years, 69% male; 27% persistent AF, CHADSVASC score: 2.3 ± 1.5; left ventricular ejection fraction: 56 ± 10%, oral anticoagulation with warfarin/direct oral anticoagulants: n = 11/15), referred for first‐time AF ablation, CBA of the pulmonary veins and extrapulmonary LA substrates was performed (median: 12 [interquartile range {IQR}: 7‐14] freezes over 1675 seconds [IQR: 1168‐2160]). On LGE‐MRI, significant postablation cryoballoon‐induced LA scar (median: 19.4% [IQR: 13.4‐24.7] in comparison to baseline preablation LA‐LGE (median: 10.6% [IQR 3.1‐13.1]; P = .01) was found. Freedom from AF recurrence at 12 months was 74.5% with median time‐to‐recurrence of 242 days (IQR: 172‐298). In 15 of 26 (58%) patients, esophageal enhancement on the postablation MRI was present with full recovery after 3 months. No major periprocedural complications were observed. Conclusion LA substrate modification in addition to PVI using LGE‐MRI‐guided CBA is feasible but still experimental. The efficacy and safety have to be investigated in a prospective randomized trial.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 97%