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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Aortic regurgitation caused by leaflet perforation is most frequently seen in association with infective endocarditis that involves the aortic valve. There have been occasional reports of iatrogenic aortic regurgitation caused by aortic valve injury after cardiac surgery with the use of the transaortic approach or invasive cardiac procedures. Suture-related aortic valve injury can develop during periaortic cardiac surgery, but this has been very rarely reported. Inadvertent injury to an aortic valve leaflet caused by a stitching needle or surgical forceps can produce leaflet perforation with aortic regurgitation. This report describes a case of aortic regurgitation that was caused by iatrogenic aortic valve leaflet perforation, and this occurred in a 22-year-old woman who underwent repair of a ventricular septal defect (VSD) 15 years previously. Transthoracic echocardiography (TTE) showed a defect located at the aortic annulus close to the infundibular septum on a two-dimensional echocardiographic study and we observed an eccentric jet flow into the left ventricle in early diastole on the continuous wave and color flow Doppler studies. A small perforation in the body of the right aortic cusp and mild to moderate aortic regurgitation were confirmed by the use of transesophageal echocardiography (TEE) and ascending aortography.