MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation

Irfan M. Khurram, John N. Catanzaro, Stefan Zimmerman, Vadim Zipunnikov, Ronald D. Berger, Alan Cheng, Sunil Sinha, Jane Dewire, Joseph Marine, David Spragg, Hiroshi Ashikaga, Henry Halperin, Hugh Calkins, Saman Nazarian

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Abstract

Background Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF. Methods Seventeen patients with AF underwent initial pulmonary vein (PV) isolation (PVI) using RF (n = 7), Cryo (n = 5), and Laser (n = 5). LGE-MRI was performed prior to and at 24 hours and 3 months after PVI. Results In a linear mixed-effects model, accounting for intrapatient clustering of data and interpatient differences in baseline scar, LGE extent was significantly increased at 24 hours postablation (+14.6 ± 1.9% of LA myocardium, P < 0.001), and remained stable from 24 hours to 3 months (+0.12 ± 1.9%, P = 0.951). There was no statistically significant difference between the postablation scar extent among ablation modalities when compared to RF (Cryo +4.5 ± 3.0%, P = 0.123; Laser -3.2 ± 3.0%, P = 0.291). The PV antral LGE intensity was increased by 25.1 ± 3.8% (P<0.001) 24 hours after ablation and additionally increased by 8.1 ± 3.8 at 3 months (P = 0.033). Conclusions Radiofrequency, Cryo, and laser ablation result in increased LGE extent and intensity at 24 hours and 3 months postablation. No statistically significant difference was noted in the extent of fibrosis induced by any modality.

Original languageEnglish (US)
Pages (from-to)1317-1324
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number11
DOIs
StatePublished - Nov 2015

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Keywords

  • Cryothermal
  • Laser
  • ablation
  • atrial fibrillation
  • imaging
  • radiofrequency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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