Advancements in Imaging for Atrial Fibrillation Ablation: Is There a Potential to Improve Procedural Outcomes?

Abstract

Since the introduction of atrial fibrillation (AF) ablation in the 1990s, the procedure has continuously evolved, with gradual improvements in outcomes and safety. Recent technological advancements include the introduction of contact force catheters and high-resolution electroanatomical mapping systems, while imaging modalities including transesophageal echocardiography and fluoroscopy have become integral parts of AF ablation procedures. Further, intraprocedural intracardiac echocardiography and the integration of cardiac magnetic resonance and computed tomography images with electroanatomical mapping have shown promise to improve procedural outcomes by reducing radiation exposure and procedural times. However, available data on procedural utility and the reduction in AF recurrence rates associated with these modalities are mixed. This review therefore aims to discuss the current common imaging modalities used in AF ablation and their potential impact on outcomes. In particular, imaging is discussed with respect to the important information it offers before, during, and after the procedure. Perspectives on the future of imaging in AF ablation are also shared.

Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation.

“…Catheter ablation has been established as a standard treatment for symptomatic AF and PVI has become the cornerstone of such treatment, as recommended in the current guidelines (8) . Several studies have shown that advanced cardiac imaging techniques can improve AF ablation result (9,10) . Both CT scan and CMR provide accurate anatomic details (i.e.…”

Medical image analysis on left atrial LGE MRI for atrial fibrillation studies: A review

“…Medical images can offer crucial information for the evaluation and treatment of AF patients, and have been widely used in the ablation process ( Tops et al, 2010 ; Obeng-Gyimah and Nazarian, 2020 ). Table 4 summarizes the common imaging modalities used in three ablation stages (before, during, and after catheter ablation), mainly referring to Tops et al (2010) and Obeng-Gyimah and Nazarian (2020) . One can see that diverse imaging modalities have been introduced in the ablation process, each of which assists in various aspects of the procedure.…”

“…PV anatomy can also be measured by TEE, achieving up to 95% concordance with MRI ( Toffanin et al, 2006 ). Moreover, cardiac MRI remains the gold standard for fibrosis assessment ( Obeng-Gyimah and Nazarian, 2020 ). Especially, LGE MRI appears to be a promising alternative for pre-ablation scar visualization and quantification ( Siebermair et al, 2017 ).…”

Medical Image Analysis on Left Atrial LGE MRI for Atrial Fibrillation Studies: A Review

“…Medical images can offer crucial information for the evaluation and treatment of AF patients, and have been widely used in the ablation process (Tops et al, 2010;Obeng-Gyimah and Nazarian, 2020). Table 5 summarizes the common imaging modalities used in three ablation stages.…”