Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation

Success and limitations

David D Spragg, Irfan Khurram, Stefan Zimmerman, Hirad Yarmohammadi, Bernie Barcelon, Matthew Needleman, David Edwards, Joseph Marine, Hugh Calkins, Saman Nazarian

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Ablation for atrial fibrillation (AF) frequently requires multiple procedures to achieve durable restoration of sinus rhythm. Early studies have suggested that delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium (LA) can assist in performing repeat ablation procedures. OBJECTIVE: The purpose of this study was to investigate the utility of DE-MRI in delineating regions of LA low voltage and PV reconnection sites in patients undergoing repeat PV isolation for recurrent AF. METHODS: We enrolled 10 patients undergoing repeat ablation for AF recurrence to undergo preprocedural DE-MRI of the LA in conjunction with high-density voltage mapping (>100 sites) of the LA during the ablation procedure. LA wall regions with hyperenhancement were segmented from DE-MRI images and retrospectively co-registered with the electroanatomic LA map. The association between scar on DE-MRI images and low-voltage regions of the LA was assessed, as was the association between scar gaps and electrogram-determined PV reconnection sites. RESULTS: Ten patients underwent successful DE-MRI imaging and repeat AF ablation without complication. In all 10 patients, the majority of PVs were found to have regained electrical continuity with the LA (30/37 PVs electrically active); all patients underwent successful reisolation of all PVs using standard ablation techniques. There was a significant association between scar identified by DE-MRI and low-voltage regions of the LA (-0.7±0.1 mV in scar regions; generalized estimating equations model clustered by patient, P

Original languageEnglish (US)
Pages (from-to)2003-2009
Number of pages7
JournalHeart Rhythm
Volume9
Issue number12
DOIs
StatePublished - Dec 2012

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Heart Atria
Atrial Fibrillation
Cicatrix
Magnetic Resonance Imaging
Ablation Techniques
Recurrence

Keywords

  • Ablation
  • Atrial fibrillation
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation : Success and limitations. / Spragg, David D; Khurram, Irfan; Zimmerman, Stefan; Yarmohammadi, Hirad; Barcelon, Bernie; Needleman, Matthew; Edwards, David; Marine, Joseph; Calkins, Hugh; Nazarian, Saman.

In: Heart Rhythm, Vol. 9, No. 12, 12.2012, p. 2003-2009.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Ablation for atrial fibrillation (AF) frequently requires multiple procedures to achieve durable restoration of sinus rhythm. Early studies have suggested that delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium (LA) can assist in performing repeat ablation procedures. OBJECTIVE: The purpose of this study was to investigate the utility of DE-MRI in delineating regions of LA low voltage and PV reconnection sites in patients undergoing repeat PV isolation for recurrent AF. METHODS: We enrolled 10 patients undergoing repeat ablation for AF recurrence to undergo preprocedural DE-MRI of the LA in conjunction with high-density voltage mapping (>100 sites) of the LA during the ablation procedure. LA wall regions with hyperenhancement were segmented from DE-MRI images and retrospectively co-registered with the electroanatomic LA map. The association between scar on DE-MRI images and low-voltage regions of the LA was assessed, as was the association between scar gaps and electrogram-determined PV reconnection sites. RESULTS: Ten patients underwent successful DE-MRI imaging and repeat AF ablation without complication. In all 10 patients, the majority of PVs were found to have regained electrical continuity with the LA (30/37 PVs electrically active); all patients underwent successful reisolation of all PVs using standard ablation techniques. There was a significant association between scar identified by DE-MRI and low-voltage regions of the LA (-0.7±0.1 mV in scar regions; generalized estimating equations model clustered by patient, P",
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T2 - Success and limitations

AU - Spragg, David D

AU - Khurram, Irfan

AU - Zimmerman, Stefan

AU - Yarmohammadi, Hirad

AU - Barcelon, Bernie

AU - Needleman, Matthew

AU - Edwards, David

AU - Marine, Joseph

AU - Calkins, Hugh

AU - Nazarian, Saman

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N2 - BACKGROUND: Ablation for atrial fibrillation (AF) frequently requires multiple procedures to achieve durable restoration of sinus rhythm. Early studies have suggested that delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium (LA) can assist in performing repeat ablation procedures. OBJECTIVE: The purpose of this study was to investigate the utility of DE-MRI in delineating regions of LA low voltage and PV reconnection sites in patients undergoing repeat PV isolation for recurrent AF. METHODS: We enrolled 10 patients undergoing repeat ablation for AF recurrence to undergo preprocedural DE-MRI of the LA in conjunction with high-density voltage mapping (>100 sites) of the LA during the ablation procedure. LA wall regions with hyperenhancement were segmented from DE-MRI images and retrospectively co-registered with the electroanatomic LA map. The association between scar on DE-MRI images and low-voltage regions of the LA was assessed, as was the association between scar gaps and electrogram-determined PV reconnection sites. RESULTS: Ten patients underwent successful DE-MRI imaging and repeat AF ablation without complication. In all 10 patients, the majority of PVs were found to have regained electrical continuity with the LA (30/37 PVs electrically active); all patients underwent successful reisolation of all PVs using standard ablation techniques. There was a significant association between scar identified by DE-MRI and low-voltage regions of the LA (-0.7±0.1 mV in scar regions; generalized estimating equations model clustered by patient, P

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