Drs. Sohns and Karim contributed equally to this work.
Quantitative Magnetic Resonance Imaging Analysis of the Relationship Between Contact Force and Left Atrial Scar Formation After Catheter Ablation of Atrial Fibrillation
Version of Record online: 8 NOV 2013
© 2013 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 25, Issue 2, pages 138–145, February 2014
How to Cite
SOHNS, C., KARIM, R., HARRISON, J., ARUJUNA, A., LINTON, N., SENNETT, R., LAMBERT, H., LEO, G., WILLIAMS, S., RAZAVI, R., WRIGHT, M., SCHAEFFTER, T., O'NEILL, M. and RHODE, K. (2014), Quantitative Magnetic Resonance Imaging Analysis of the Relationship Between Contact Force and Left Atrial Scar Formation After Catheter Ablation of Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 25: 138–145. doi: 10.1111/jce.12298
Dr. Sohns is funded by the German Cardiac Society (Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung/DGK) through a grant for clinical research. The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy's & St. Thomas’ NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
C. Sohns reports a small travel grant from Endosense. K.S. Rhode reports research equipment support for this study from Endosense. M. Wright reports modest honoraria relevant to this study. H. Lampert and L. Giovanni are employed by Endosense and are owners/inventors listed on the FTI patent. Other authors: No disclosures.
Some of the data in this manuscript were presented in poster form at the Heart Rhythm Society sessions in 2013.
- Issue online: 12 FEB 2014
- Version of Record online: 8 NOV 2013
- Accepted manuscript online: 3 OCT 2013 10:35AM EST
- Manuscript Accepted: 20 SEP 2013
- Manuscript Revised: 15 SEP 2013
- Manuscript Received: 26 JUL 2013
- Department of Health via the National Institute for Health Research (NIHR)
- atrial fibrillation;
- catheter ablation;
- contact force;
- left atrium;
- magnetic resonance imaging;
- pulmonary vein isolation
Left Atrial Scar Formation After Contact Force-Guided AF Ablation
Catheter contact force (CF) is an important determinant of radiofrequency (RF) lesion quality during pulmonary vein isolation (PVI). Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) allows good visualization of ablation lesions.
This study describes a new technique to examine the relationship between CF during RF delivery and LGE signal intensity (SI) following PVI.
Six patients underwent PVI for paroxysmal AF using a CF-sensing catheter and following preprocedural MRI. During ablation, CF-time integral (FTI) and position was documented for each RF application. All patients underwent repeat LGE MRI 3 months later. The LGE SIs were projected onto a MRI-derived 3-dimensional left atrial (LA) shell and a CF map was generated on the same shell. The entire LA surface was divided into 5 mm2 segments. Force and LGE maps were fused and compared for each 5 mm2 zone. An effective lesion was defined when MRI-defined scar occupied >90% of a 5 mm2 analysis zone.
Acute PVI was achieved in 100%. Two hundred sixty-eight RF lesions were tagged on the LA shells and given a lesion-specific FTI. Increasing FTI correlated with increased LGE SI, which was greater when the FTI was > 1,200 gs. Below an FTI of 1,200 gs, an increment in the FTI resulted in only a small increment in scar, whereas above 1,200 gs an increment in the FTI resulted in a large change of scar.
There is a correlation between FTI and LGE SI in MRI following AF ablation. Real-time FTI maps are feasible and may prevent inadequate lesion formation.