Temporal left atrial lesion formation after ablation of atrial fibrillation

Badger, Troy J.; Oakes, Robert S.; Daccarett, Marcos; Burgon, Nathan; Akoum, Nazem; Fish, Eric N.; Blauer, Joshua; Rao, Sanjana; Adjei-Poku, Yaw A.; Kholmovski, Eugene; Vijayakumar, Sathya; Bella, E.V.R. Di; MacLeod, Rob S.; Marrouche, Nassir F.

doi:10.1016/j.hrthm.2008.10.042

Cited by 92 publications

(92 citation statements)

References 31 publications

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“…Theoretical assumptions suppose changes in lesion size over time as inflammation and healing appear, and this has just recently been reported regarding long-term follow-up of ablation lesions, 8 and also in the short-term follow-up. 3 In contrast, investigations in our setup showed that the visualized lesion size was not significantly changing over time immediately after ablation and during subacute follow-up but remained constant during the first hours after the initial measurements ( Figure 3 and Figure 4).…”

Section: Contrast-enhanced Versus Nonenhanced Lesion Visualizationmentioning

confidence: 96%

“…In general, contrast-enhanced MRI is a valuable tool for lesion visualization, being a standard procedure offering relatively easy visualization of ablation lesions with good detectability even of small atrial lesions in patients. 7,8 On the other hand, this approach is more suitable for postprocedural imaging and would be problematic in a real-time interventional approach because of limitations in the amount of contrast agent Figure 5. Contrast-enhanced lesion visualization in patients after atrial flutter ablation.…”

Section: Mri For Electrophysiological Lesion Visualizationmentioning

confidence: 99%

“…Providing unsurpassed soft tissue contrast, MRI may also help identifying the arrhythmogenic substrate or even directly visualize therapeutic lesions after interventional electrophysiological procedures, as demonstrated before. [1][2][3][4][5][6][7][8] Intraprocedural accurate feedback of lesion formation during therapy could reduce procedural time and patient risk and increase efficacy of electrophysiological interventions. These potential advantages position magnetic resonance-guided electrophysiology uniquely for complex interventions in the near future.…”

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confidence: 99%

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Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Nordbeck

Hiller²,

Fidler³

et al. 2011

Circ: Cardiovascular Imaging

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Background-Imaging of myocardial ablation lesions during electrophysiology procedures would enable superior guidance of interventions and immediate identification of potential complications. The aim of this study was to establish clinically suitable MRI-based imaging techniques for intraprocedural lesion visualization in interventional electrophysiology. Methods and Results-Interventional electrophysiology was performed under magnetic resonance guidance in an animal model, using a custom setup including magnetic resonance-conditional catheters. Various pulse sequences were explored for intraprocedural lesion visualization after radiofrequency ablation. The developed visualization techniques were then used to investigate lesion formation in patients immediately after ablation of atrial flutter. The animal studies in 9 minipigs showed that gadolinium-DTPA-enhanced T1-weighted and nonenhanced T2-weighted pulse sequences are particularly suitable for lesion visualization immediately after radiofrequency ablation. MRI-derived lesion size correlated well with autopsy (R 2 ϭ0.799/0.709 for contrast-enhanced/nonenhanced imaging). Non-contrast agentenhanced techniques were suitable for repetitive lesion visualization during electrophysiological interventions, thus allowing for intraprocedural monitoring of ablation success. The patient studies in 24 patients with typical atrial flutter several minutes to hours after cavotricuspid isthmus ablation confirmed the results from the animal experiments. Therapeutic lesions could be visualized in all patients using contrast-enhanced and also nonenhanced MRI with high contrast-to-noise ratio (94.6Ϯ35.2/111.1Ϯ32.6 versus 48.0Ϯ29.0/68.0Ϯ37.3 for ventricular/atrial lesions and contrastenhanced versus nonenhanced imaging). Conclusions-MRI allows for precise lesion visualization in electrophysiological interventions just minutes after radiofrequency ablation. Nonenhanced T2-weighted MRI is particularly feasible for intraprocedural delineation of lesion formation as lesions are detectable within minutes after radiofrequency delivery and imaging can be repeated during interventions. (Circ Cardiovasc Imaging. 2011;4:282-294.)

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Section: Contrast-enhanced Versus Nonenhanced Lesion Visualizationmentioning

confidence: 96%

Section: Mri For Electrophysiological Lesion Visualizationmentioning

confidence: 99%

mentioning

confidence: 99%

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Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Nordbeck

Hiller²,

Fidler³

et al. 2011

Circ: Cardiovascular Imaging

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“…Atrium (LA) have been studied with Magnetic Resonance Imaging (MRI) using both Late Gadolinium Enhancement (LGE) and T2-Weighted (T2w) imaging sequences [3,4]. The late post-ablation scar that results from ablation injury to the myocardium can be visualized on LGE MRI and has been described previously [5,6,7]. More recently, there has been increasing interest in visualizing the immediate post ablation injury to better understand its effect on LA remodeling and the success of the procedure [8].…”

mentioning

confidence: 99%

“…Study of the acute ablation injury using T2w sequences also has been described. Within 24 hours post-ablation, increased T2 signal is seen in regions with injuries both transient (edema and inflammation) and permanent (tissue necrosis becoming scar) [7,11,12,13]. As a result, postablation T2 signal is not seen as a good predictor of subsequent scar formation [14].…”

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confidence: 99%

Dynamic T2 Signal Changes on MRI after Radiofrequency Ablation Injury to the Atrial Myocardium

Rassa¹

2015

JCTCD

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Purpose: Radiofrequency Ablation (RFA) is an effective therapy for Atrial Fibrillation (AF) and can result in cure. Post-ablation injury is well visualized on T2 Weighted (T2w) Cardiac Magnetic Resonance Imaging (CMRI) sequences but does not correlate well with scar formation. However, the change in T2 signal over time has not been well described and may still prove to be clinically useful. Methods and Results:A total of 29 patients presenting for Pulmonary Vein Isolation (PVI) for the treatment of AF underwent serial T2w CMRI before and after the procedure. Immediate RFA lesions were characterized by T2w imaging during CMRI guided ablations in a porcine model (6 pigs). All ablation procedures were performed in an Electrophysiology-Magnetic Resonance Imaging (EP-MRI) suite with an imaging on a 3 Tesla scanner. Study of the Left Atrial (LA) injury response on CMRI scans showed increased T2w signal seconds after ablation, involved a majority of the LA wall within 24 hours, and resolved in less than a week. Conclusion:RFA injury to the LA myocardium causes inflammatory changes on T2w MRI that begin immediately after energy delivery and spread rapidly to the surrounding tissue. These MRI findings may be of clinical interest as tissue injury from the initial RFA lesions may influence the success of lesions delivered later in the procedure. Atrium (LA) have been studied with Magnetic Resonance Imaging (MRI) using both Late Gadolinium Enhancement (LGE) and T2-Weighted (T2w) imaging sequences [3,4]. The late post-ablation scar that results from ablation injury to the myocardium can be visualized on LGE MRI and has been described previously [5,6,7]. More recently, there has been increasing interest in visualizing the immediate post ablation injury to better understand its effect on LA remodeling and the success of the procedure [8]. Within 24 hours post-ablation, dark regions of no-reflow on LGE MRI have been shown to correlate with regions of myocardium that eventually become scarred [9,10]. Study of the acute ablation injury using T2w sequences also has been described. Within 24 hours post-ablation, increased T2 signal is seen in regions with injuries both transient (edema and inflammation) and permanent (tissue necrosis becoming scar) [7,11,12,13]. As a result, postablation T2 signal is not seen as a good predictor of subsequent scar formation [14].While post-ablation T2 signal has been shown to increase and even expand beyond the sites of ablation injury [10,13], the time of onset and resolution of T2 signal following ablation is not well studied. In this paper we describe the temporal course of postablation injury on T2w imaging using data from humans and a porcine model. The dynamic T2 signal changes post-ablation and may provide important clinical information when considering the atrial response to RFA injury. MethodsPatient's data was obtained from the patients in the University of Utah AF Database. From June 2009 to December 2012, patients who underwent PVI with posterior and septal wall debulking in our...

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MRI‐guided procedures

Halperin

Kolandaivelu

2015

Practical Guide to Catheter Ablation of Atrial Fibrillation

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Temporal left atrial lesion formation after ablation of atrial fibrillation

Cited by 92 publications

References 31 publications

Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Dynamic T2 Signal Changes on MRI after Radiofrequency Ablation Injury to the Atrial Myocardium

MRI‐guided procedures

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