New Magnetic Resonance Imaging-Based Method for Defining the Extent of Left Atrial Wall Injury After the Ablation of Atrial Fibrillation

McGann, Christopher; Kholmovski, Eugene; Oakes, Robert S.; Blauer, Joshua; Daccarett, Marcos; Segerson, Nathan M.; Airey, Kelly J.; Akoum, Nazem; Fish, Eric N.; Badger, Troy J.; DiBella, Edward; Parker, Dennis L.; MacLeod, Rob S.; Marrouche, Nassir F.

doi:10.1016/j.jacc.2008.05.062

Cited by 303 publications

(262 citation statements)

References 49 publications

Supporting

Mentioning

251

Contrasting

Unclassified

Order By: Relevance

“…420,421 Recently, a number of studies have used CMR DE late gadolinium enhancement (LGE) in order to non-invasively characterize the extent and distribution of scarring present following AF ablation. [422][423][424] Several studies observed that patients with more extensive scar at 3 months (or greater percentage scar around the PV circumference) had a lower AF recurrence rate. 423,425 Another study showed a correlation between measured contact force at the time of ablation, and the extent of CMR determined scar development.…”

Section: Magnetic Resonance Imaging Of the Atriummentioning

confidence: 99%

“…[422][423][424] Several studies observed that patients with more extensive scar at 3 months (or greater percentage scar around the PV circumference) had a lower AF recurrence rate. 423,425 Another study showed a correlation between measured contact force at the time of ablation, and the extent of CMR determined scar development. 426 Other studies have shown a concordance between scar around the PVs and low-voltage regions on invasive electroanatomic mapping (EAM).…”

Section: Magnetic Resonance Imaging Of the Atriummentioning

confidence: 99%

See 1 more Smart Citation

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

View full text Add to dashboard Cite

Section: Magnetic Resonance Imaging Of the Atriummentioning

confidence: 99%

Section: Magnetic Resonance Imaging Of the Atriummentioning

confidence: 99%

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

et al. 2016

View full text Add to dashboard Cite

“…Some groups have recommended the use of cardiac MRIdetected left atrial delayed gadolinium enhancement [37][38][39] for the identification of patients in whom AF is likely to recur after catheter ablation 38,40,41 , although an external validation of the feasibility of this technique is needed 42 . The CHARGE AF consortium identified a set of clinical parameters and biomarkers that could be used to predict AF incidence during follow-up, but did not provide information on the most appropriate prevention or therapy approach 43 .…”

Section: Guidance Through Af Characterizationmentioning

confidence: 99%

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

et al. 2015

View full text Add to dashboard Cite

Despite the important advances that have enabled better stroke prevention in atrial fibrillation (AF) and more effective maintenance of sinus rhythm over the past decades, a large unmet need to improve the prevention and treatment of AF remains. Mortality for AF remains at 3.5% per year, and death is often experienced as sudden death or as a result of heart failure 1,2 . Each year, approximately 20% of patients with AF need to be hospitalized 3,4 , and stroke occurs in 1.5% of patients with AF who are receiving anticoagulant drugs 5 . Furthermore, more than half of the patients with AF are symptomatic despite adequate anticoagulation and rate control 4,6 . In view of the projected increase in the incidence and prevalence of AF 7-9 , as well as the substantial burden of death and dis ability that is still associated with this condition 10 , the status quo is unacceptable.Current management of patients with AF comprises treatment of the accompanying cardiovascular conditions, oral anticoagulation, rate control -with medications that slow atrioventricular nodal recovery or, rarely, with atrioventricular nodal ablation -and rhythm-control therapy with antiarrhythmic drugs, electrical cardioversion, catheter ablation or, at times, AF surgery 11,12 . Unfortunately, most of these current approaches are disconnected from our understanding of the major mechanisms that cause AF 1,13,14 1,2,7,19,20 Abstract | Despite remarkable advances in antiarrhythmic drugs, ablation procedures, and stroke-prevention strategies, atrial fibrillation (AF) remains an important cause of death and disability in middle-aged and elderly individuals. Unstructured management of patients with AF sharply contrasts with our detailed, although incomplete, knowledge of the mechanisms that cause AF and its complications. Altered calcium homeostasis, atrial fibrosis and ageing, ion-channel dysfunction, autonomic imbalance, fat-cell infiltration, and oxidative stress, in addition to a susceptible genetic background, contribute to the promotion, maintenance, and progression of AF. However, clinical management of patients with AF is currently guided by stroke risk parameters, AF pattern, and symptoms. In response to this apparent disconnect between the known pathophysiology of AF and clinical management, we propose a roadmap to develop a set of clinical markers that reflect the major causes of AF in patients. Thereby, the insights into the mechanisms causing AF will be transformed into a format that can underpin future personalized strategies to prevent and treat AF, ultimately informing better patient care.230 | APRIL 2016 | VOLUME 13 www.nature.com/nrcardio CONSENSUS STATEMENT © 2 0 1 6 M a c m i l l a n P u b l i s h e r s L i m i t e d . A l l r i g h t s r e s e r v e d .

show abstract

“…Nevertheless, VENC-CMR measurements appear to be potentially useful to differentiate low-risk patients with fully recovered active LAA emptying from high-risk patients with permanently missing active LAA emptying. Furthermore, VENC-CMR could be used in combination with LGE CMR to longitudinally monitor recovery of active LAA emptying and its relationship to the extent of ablation lesions [23,24]. …”

Section: Discussionmentioning

confidence: 99%

Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying

Muellerleile

Sultan

Groth

et al. 2012

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

BackgroundThe presence of impaired left atrial appendage (LAA) function identifies patients who are prone to thrombus formation in the LAA and therefore being at high risk for subsequent cardioembolic stroke. LAA function is typically assessed by measurements of LAA emptying velocities using transesophageal echocardiography (TEE) in clinical routine. This study aimed at evaluating the feasibility of assessing LAA emptying by velocity encoded (VENC) cardiovascular magnetic resonance (CMR).MethodsThis study included 30 patients with sinus rhythm (n = 18) or atrial fibrillation (n = 12). VENC-CMR velocity measurements were performed perpendicular to the orifice of the LAA. Peak velocities were measured of passive diastolic LAA emptying (e-wave) in all patients. Peak velocities of active, late-diastolic LAA emptying (a-wave) were assessed in patients with sinus rhythm. Correlation and agreement was analyzed between VENC-CMR and TEE measurements of e- and a-wave peak velocities.ResultsA significant correlation and good agreement was found between VENC-CMR and TEE measurements of maximal e-wave velocities (r = 0.61, P < 0.001; mean difference 0 ± 10 cm/s). The a-wave was detectable by VENC-CMR in all patients with sinus rhythm. Correlation was also significant for measurements of peak a-wave velocities between VENC-CMR and TEE (r = 0.71, P < 0.001). There was no significant correlation of LAA emptying velocities with clinical characteristics and only a modest negative correlation of passive LAA emptying with LA function.ConclusionsThe assessment of active and passive LAA emptying by VENC-CMR is feasible. Further evaluation is required of potential future clinical applications such as risk stratification for cardioembolic stroke.

show abstract

New Magnetic Resonance Imaging-Based Method for Defining the Extent of Left Atrial Wall Injury After the Ablation of Atrial Fibrillation

Abstract: We define noninvasive MRI methods that allow for the detection and quantification of LA wall scarring after RF ablation in patients with AF. Moreover, there seems to be a correlation between the extent of LA wall injury and short-term procedural outcome.

Cited by 303 publications

References 49 publications

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

Defining the major health modifiers causing atrial fibrillation: a roadmap to underpin personalized prevention and treatment

Velocity encoded cardiovascular magnetic resonance to assess left atrial appendage emptying

Contact Info

Product

Resources

About