This work was funded by the British Heart Foundation (RG/10/11/28457 and Center of Research Excellence Programme) and the National Institute for Health Research as part of Barts and The London NIHR Cardiovascular Biomedical Research Unit and Imperial College Healthcare NHS Trust Biomedical Research Center.
Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Detection and Characterization of Left Atrial Catheter Ablation Lesions: A Multicenter Experience
Article first published online: 7 JAN 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 24, Issue 4, pages 396–403, April 2013
How to Cite
HUNTER, R. J., JONES, D. A., BOUBERTAKH, R., MALCOLME-LAWES, L. C., KANAGARATNAM, P., JULI, C. F., DAVIES, D. W., PETERS, N. S., BAKER, V., EARLEY, M. J., SPORTON, S., DAVIES, L. C., WESTWOOD, M., PETERSEN, S. E. and SCHILLING, R. J. (2013), Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Detection and Characterization of Left Atrial Catheter Ablation Lesions: A Multicenter Experience. Journal of Cardiovascular Electrophysiology, 24: 396–403. doi: 10.1111/jce.12063
Dr. Davies is a member of the Medtronic advisory board. Other authors: No disclosures.
- Issue published online: 1 APR 2013
- Article first published online: 7 JAN 2013
- Accepted manuscript online: 27 NOV 2012 06:45PM EST
- Manuscript received 17 June 2012; Revised manuscript received 19 October 2012; Accepted for publication 29 October 2012.
- atrial fibrillation;
- catheter ablation;
- late gadolinium enhancement;
- pulmonary vein isolation
MRI Detection of Left Atrial Ablation Lesions. Introduction: We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre- and postablation imaging.
Methods: Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre- or postablation, and if postablation, whether lesions were in an ostial or WACA distribution.
Results: LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000).
Conclusion: LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution. (J Cardiovasc Electrophysiol, Vol. 24, pp. 396-403, April 2013)