Document Detail


Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation.
MedLine Citation:
PMID:  21718914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess acute ablation injuries seen on late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) immediately post-ablation (IPA) and the association with permanent scar 3 months post-ablation (3moPA).
BACKGROUND: Success rates for atrial fibrillation catheter ablation vary significantly, in part because of limited information about the location, extent, and permanence of ablation injury at the time of procedure. Although the amount of scar on LGE MRI months after ablation correlates with procedure outcomes, early imaging predictors of scar remain elusive.
METHODS: Thirty-seven patients presenting for atrial fibrillation ablation underwent high-resolution MRI with a 3-dimensional LGE sequence before ablation, IPA, and 3moPA using a 3-T scanner. The acute left atrial wall injuries on IPA scans were categorized as hyperenhancing (HE) or nonenhancing (NE) and compared with scar 3moPA.
RESULTS: Heterogeneous injuries with HE and NE regions were identified in all patients. Dark NE regions in the left atrial wall on LGE MRI demonstrate findings similar to the "no-reflow" phenomenon. Although the left atrial wall showed similar amounts of HE, NE, and normal tissue IPA (37.7 ± 13%, 34.3 ± 14%, and 28.0 ± 11%, respectively; p = NS), registration of IPA injuries with 3moPA scarring demonstrated that 59.0 ± 19% of scar resulted from NE tissue, 30.6 ± 15% from HE tissue, and 10.4 ± 5% from tissue identified as normal. Paired t-test comparisons were all statistically significant among NE, HE, and normal tissue types (p < 0.001). Arrhythmia recurrence at 1-year follow-up correlated with the degree of wall enhancement 3moPA (p = 0.02).
CONCLUSIONS: Radiofrequency ablation results in heterogeneous injury on LGE MRI with both HE and NE wall lesions. The NE lesions demonstrate no-reflow characteristics and reveal a better predictor of final scar at 3 months. Scar correlates with procedure outcomes, further highlighting the importance of early scar prediction.
Authors:
Christopher McGann; Eugene Kholmovski; Joshua Blauer; Sathya Vijayakumar; Thomas Haslam; Joshua Cates; Edward DiBella; Nathan Burgon; Brent Wilson; Alton Alexander; Marcel Prastawa; Marcos Daccarett; Gaston Vergara; Nazem Akoum; Dennis Parker; Rob MacLeod; Nassir Marrouche
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-01     Completed Date:  2011-09-06     Revised Date:  2013-08-20    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-85     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt Lake City, Utah 84132, USA. chris.mcgann@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / therapy*
Cardiology / methods*
Catheter Ablation
Cicatrix / pathology
Cohort Studies
Contrast Media / pharmacology
Diagnostic Imaging / methods
Electrophysiology / methods
Gadolinium / pharmacology*
Heart Atria / pathology
Humans
Image Processing, Computer-Assisted / methods
Kinetics
Magnetic Resonance Imaging / methods*
Observer Variation
Reproducibility of Results
Grant Support
ID/Acronym/Agency:
2P41 RR0112553-12/RR/NCRR NIH HHS; P41 GM103545/GM/NIGMS NIH HHS; P41 RR012553/RR/NCRR NIH HHS; P41-RR12553-10/RR/NCRR NIH HHS; U54 EB005149/EB/NIBIB NIH HHS; U54 EB005149/EB/NIBIB NIH HHS
Chemical
Reg. No./Substance:
0/Contrast Media; 7440-54-2/Gadolinium
Comments/Corrections

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