This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by McGann, C. J. Articles by Marrouche, N. F. Search for Related Content PubMed PubMed Citation Articles by McGann, C. J. Articles by Marrouche, N. F. Related Collections Related Articles

CLINICAL RESEARCH: CARDIAC IMAGING

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

Christopher J. McGann, MD^_*, Eugene G. Kholmovski, PhD^_*, Robert S. Oakes, BS^,, Joshua J.E. Blauer, BS^,, Marcos Daccarett, MD, Nathan Segerson, MD, Kelly J. Airey, MD, Nazem Akoum, MD, Eric Fish^,, Troy J. Badger, MD, Edward V.R. DiBella, PhD^_*,, Dennis Parker, PhD^_*,, Rob S. MacLeod, PhD^, and Nassir F. Marrouche, MD^,_*

^_* Radiology Department, University of Utah School of Medicine, University of Utah, Salt Lake City, Utah
Division of Cardiology, Internal Medicine, University of Utah School of Medicine, University of Utah, Salt Lake City, Utah
Bioengineering Department, University of Utah, Salt Lake City, Utah

Manuscript received February 22, 2008; revised manuscript received April 11, 2008, accepted May 5, 2008.

^_* Reprint requests and correspondence: Dr. Nassir F. Marrouche, Atrial Fibrillation Program and Electrophysiology Laboratory, Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, Utah 84132-2400 (Email: nassir.marrouche{at}hsc.utah.edu).

Objectives: We describe a noninvasive method of detecting and quantifying left atrial (LA) wall injury after pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF). Using a 3-dimensional (3D) delayed-enhancement magnetic resonance imaging (MRI) sequence and novel processing methods, LA wall scarring is visualized at high resolution after radiofrequency ablation (RFA).

Background: Radiofrequency ablation to achieve PVAI is a promising approach to curing AF. Controlled lesion delivery and scar formation within the LA are indicators of procedural success, but the assessment of these factors is limited to invasive methods. Noninvasive evaluation of LA wall injury to assess permanent tissue injury may be an important step in improving procedural success.

Methods: Imaging of the LA wall with a 3D delayed-enhanced cardiac MRI sequence was performed before and 3 months after ablation in 46 patients undergoing PVAI for AF. Our 3D respiratory-navigated MRI sequence using parallel imaging resulted in 1.25 x 1.25 x 2.5 mm (reconstructed to 0.6 x 0.6 x 1.25 mm) spatial resolution with imaging times ranging 8 to 12 min.

Results: Radiofrequency ablation resulted in hyperenhancement of the LA wall in all patients post-PVAI and may represent tissue scarring. New methods of reconstructing the LA in 3D allowed quantification of LA scarring using automated methods. Arrhythmia recurrence at 3 months correlated with the degree of wall enhancement with >13% injury predicting freedom from AF (odds ratio: 18.5, 95% confidence interval: 1.27 to 268, p = 0.032).

Conclusions: 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.

Key Words: delayed enhancement magnetic resonance imaging • atrial fibrillation • image processing

Abbreviations and Acronyms   3D = three-dimensional   AF = atrial fibrillation   CI = confidence interval   DE-CMRI = delayed-enhancement cardiac magnetic resonance imaging   ECG = electrocardiogram   FLASH = fast low angle shot   GRAPPA = generalized autocalibrating partially parallel acquisitions   LA = left atrium/atrial   LV = left ventricle/ventricular   MRI = magnetic resonance imaging   OR = odds ratio   PVAI = pulmonary vein antrum isolation   RFA = radiofrequency ablation   RF = radiofrequency   TE = echo time   TI = inversion time   TR = repetition time

Related Articles

Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance

Henry R. Halperin and Saman Nazarian
J. Am. Coll. Cardiol. 2008 52: 1272-1273. [Full Text] [PDF]

This article has been cited by other articles:

				P. Kirchhof, G. Y. H. Lip, I. C. Van Gelder, J. Bax, E. Hylek, S. Kaab, U. Schotten, K. Wegscheider, G. Boriani, A. Brandes, et al. Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options--a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference Europace, January 1, 2012; 14(1): 8 - 27. [Abstract] [Full Text] [PDF]

				P. G. Platonov, L. B. Mitrofanova, V. Orshanskaya, and S. Y. Ho Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J. Am. Coll. Cardiol., November 15, 2011; 58(21): 2225 - 2232. [Abstract] [Full Text] [PDF]

				S. J. Asirvatham and J. J. Gard Wrinkles in the atrium: age, atrial fibrillation, or something else. J. Am. Coll. Cardiol., November 15, 2011; 58(21): 2233 - 2235. [Full Text] [PDF]

				D. W. den Uijl, V. Delgado, M. Bertini, L. F. Tops, S. A. Trines, N. R. van de Veire, K. Zeppenfeld, M. J. Schalij, and J. J. Bax Impact of left atrial fibrosis and left atrial size on the outcome of catheter ablation for atrial fibrillation Heart, November 15, 2011; 97(22): 1847 - 1851. [Abstract] [Full Text] [PDF]

				C. McGann, E. Kholmovski, J. Blauer, S. Vijayakumar, T. Haslam, J. Cates, E. DiBella, N. Burgon, B. Wilson, A. Alexander, et al. Dark Regions of No-Reflow on Late Gadolinium Enhancement Magnetic Resonance Imaging Result in Scar Formation After Atrial Fibrillation Ablation J. Am. Coll. Cardiol., July 5, 2011; 58(2): 177 - 185. [Abstract] [Full Text] [PDF]

				A. C. Y. To, S. D. Flamm, T. H. Marwick, and A. L. Klein Clinical Utility of Multimodality LA Imaging: Assessment of Size, Function, and Structure J. Am. Coll. Cardiol. Img., July 1, 2011; 4(7): 788 - 798. [Abstract] [Full Text] [PDF]

				R. Ranjan, R. Kato, M. M. Zviman, T. M. Dickfeld, A. Roguin, R. D. Berger, G. F. Tomaselli, and H. R. Halperin Gaps in the Ablation Line as a Potential Cause of Recovery From Electrical Isolation and Their Visualization Using MRI Circ Arrhythm Electrophysiol, June 1, 2011; 4(3): 279 - 286. [Abstract] [Full Text] [PDF]

				P. Nordbeck, K.-H. Hiller, F. Fidler, M. Warmuth, N. Burkard, M. Nahrendorf, P. M. Jakob, H. H. Quick, G. Ertl, W. R. Bauer, et al. Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology: Animal Studies and Early Delineation of Isthmus Ablation Lesions in Patients With Typical Atrial Flutter Circ Cardiovasc Imaging, May 1, 2011; 4(3): 282 - 294. [Abstract] [Full Text] [PDF]

				T. J. Badger, M. Daccarett, N. W. Akoum, Y. A. Adjei-Poku, N. S. Burgon, T. S. Haslam, S. Kalvaitis, S. Kuppahally, G. Vergara, L. McMullen, et al. Evaluation of Left Atrial Lesions After Initial and Repeat Atrial Fibrillation Ablation: Lessons Learned From Delayed-Enhancement MRI in Repeat Ablation Procedures Circ Arrhythm Electrophysiol, June 1, 2010; 3(3): 249 - 259. [Abstract] [Full Text] [PDF]

				S. S. Kuppahally, N. Akoum, N. S. Burgon, T. J. Badger, E. G. Kholmovski, S. Vijayakumar, S. N. Rao, J. Blauer, E. N. Fish, E. V. R. DiBella, et al. Left Atrial Strain and Strain Rate in Patients With Paroxysmal and Persistent Atrial Fibrillation: Relationship to Left Atrial Structural Remodeling Detected by Delayed-Enhancement MRI Circ Cardiovasc Imaging, May 1, 2010; 3(3): 231 - 239. [Abstract] [Full Text] [PDF]

				K. Ilg, T. S. Baman, S. K. Gupta, S. Swanson, E. Good, A. Chugh, K. Jongnarangsin, F. Pelosi Jr, T. Crawford, H. Oral, et al. Assessment of Radiofrequency Ablation Lesions by CMR Imaging After Ablation of Idiopathic Ventricular Arrhythmias J. Am. Coll. Cardiol. Img., March 1, 2010; 3(3): 278 - 285. [Abstract] [Full Text] [PDF]

				L. F. Tops, M. J. Schalij, and J. J. Bax Imaging and atrial fibrillation: the role of multimodality imaging in patient evaluation and management of atrial fibrillation Eur. Heart J., March 1, 2010; 31(5): 542 - 551. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., February 2, 2010; 55(5): 483 - 495. [Full Text] [PDF]

				C. E. Saikus and R. J. Lederman Interventional Cardiovascular Magnetic Resonance Imaging: A New Opportunity for Image-Guided Interventions J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1321 - 1331. [Abstract] [Full Text] [PDF]

				P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation' Europace, July 1, 2009; 11(7): 860 - 885. [Full Text] [PDF]

				N. Akoum and N. F. Marrouche Real-time imaging in electrophysiology: from intra-cardiac echo to real-time magnetic resonance imaging Europace, May 1, 2009; 11(5): 539 - 540. [Full Text] [PDF]

				M. Allessie The "Second Factor": A First Step Toward Diagnosing the Substrate of Atrial Fibrillation? J. Am. Coll. Cardiol., April 7, 2009; 53(14): 1192 - 1193. [Full Text] [PDF]

				L. F. Tops and J. J. Bax The Year in Imaging Related to Electrophysiology J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510. [Full Text] [PDF]

				A. Pandit and N. F. Marrouche Cardiac Magnetic Resonance in the World of the Cardiac Electrophysiologist: The Road to Real-Time Cardiac Magnetic Resonance J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 317 - 318. [Full Text] [PDF]

				H. R. Halperin and S. Nazarian Damage Assessment After Ablation: Role of Cardiovascular Magnetic Resonance J. Am. Coll. Cardiol., October 7, 2008; 52(15): 1272 - 1273. [Full Text] [PDF]