The proposed sequences are insensitive to heart rate variability, yield improved LGE images in the presence of arrhythmias, as well as T1 mapping with shorter scan times.
Cardiovascular magnetic resonance image can identify MVP by the same echocardiographic criteria and can identify myocardial fibrosis involving the papillary muscle in MVP patients. Hyperenhancement of papillary muscles on LGE is often present in a subgroup of patients with complex ventricular arrhythmias.
Objectives
We sought to evaluate radiofrequency (RF) ablations lesions in atrial fibrillation (AF) patients using cardiovascular magnetic resonance (CMR), and to correlate the ablation patterns with treatment success.
Background
RF ablation procedures for treatment of AF result in localized scar that is detected by late gadolinium enhancement (LGE) CMR. We hypothesized that the extent of scar in the left atrium (LA) and pulmonary veins (PV) would correlate with moderate-term procedural success.
Methods
Thirty five patients with AF, undergoing their first RF ablation procedure, were studied. The RF ablation procedure was performed to achieve bi-directional conduction block around each PV ostium. AF recurrence was documented using a 7 day event monitor at multiple intervals during the first year. High spatial resolution 3D LGE CMR was performed 46±28 days after RF ablation. The extent of scarring around the ostia of each PV was quantitatively (volume of scar) and qualitatively (1-minimal, 3-extensive and circumferential) assessed.
Results
Thirteen (37%) patients had recurrent AF during the 6.7 ± 3.6 month observation period. Paroxysmal AF was a strong predictor of non-recurrent AF (15% with recurrence vs. 68% without, p=0.002). Qualitatively, patients without recurrence had more completely circumferentially scarred veins (55% vs. 35% of veins, p = NS). Patients without recurrence more frequently had scar in the inferior portion of the right inferior PV (RIPV) (82% vs. 31%, p=0.025, Bonferroni corrected). The volume of scar in the RIPV was quantitatively greater in patients without AF recurrence (p=<0.05), and was a univariate predictor of recurrence using Cox regression (p=0.049, Bonferroni corrected).
Conclusions
Among patients undergoing PV isolation, AF recurrence during the first year is associated with a lesser degree of PV and LA scarring on 3D LGE CMR. This finding was significant for RIPV scar, and may have implications for the procedural technique used in PV isolation.
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