Magnetic Resonance Imaging‐Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience

Segerson, Nathan M.; Daccarett, Marcos; Badger, Troy J.; Shabaan, Akram; Akoum, Nazem; Fish, Eric N.; Rao, Sanjana; Burgon, Nathan; Adjei-Poku, Yaw A.; Kholmovski, Eugene; Vijayakumar, Sathya; DiBella, Edward; MacLeod, Rob S.; Marrouche, Nassir F.

doi:10.1111/j.1540-8167.2009.01611.x

Cited by 88 publications

(58 citation statements)

References 42 publications

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“…Although there is a lack of clarity of what DE+T2 signals truly represent in the immediate aftermath of a catheter ablation procedure, the presence of a DE signal beyond 3-month follow-up is likely to represent permanent atrial scarring. 17,24 The formation of scar after ablation and its representation by DE+T2 sequences are not completely understood. However, there are some similarities with findings of a DE signal observed in serial CMRI (acute and late) after acute myocardial infarction, with regression of delayed enhancement areas over time.…”

Section: Atrial Scar and Arrhythmia Recurrencementioning

confidence: 99%

Acute Pulmonary Vein Isolation Is Achieved by a Combination of Reversible and Irreversible Atrial Injury After Catheter Ablation

Arujuna

Karim

Caulfield

et al. 2012

Circ: Arrhythmia and Electrophysiology

121

107

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Background-Pulmonary vein reconnection after pulmonary vein isolation is common and is usually associated with recurrences of atrial fibrillation. We used cardiac magnetic resonance imaging after radiofrequency ablation to investigate the hypothesis that acute pulmonary vein isolation results from a combination of irreversible and reversible atrial injury. Methods and Results-Delayed enhancement (DE; representing areas of acute tissue injury/necrosis) and T2-weighted (representing tissue water content, including edema) cardiac magnetic resonance scans were performed before, immediately after (acute), and later than 3 months (late) after pulmonary vein isolation in 25 patients with paroxysmal atrial fibrillation undergoing wide-area circumferential ablation. Images were analyzed as pairs of pulmonary veins to quantify the percentage of circumferential antral encirclement composed of DE, T2, and combined DE+T2 signal. Fourteen of 25 patients were atrial fibrillation free at 11-month follow-up (interquartile range, 8-16 months). These patients had higher DE (71±6.0%) and lower T2 signal (72±7.8%) encirclement on the acute scans compared with recurrences (DE, 55±9.1%; T2, 85±6.3%; P<0.05). Patients maintaining sinus rhythm had a lesser decline in DE between acute and chronic scans compared with recurrences (71±6.0% and 60±5.8% versus 55±9.1% and 34±7.3%, respectively). The percentage of encirclement by a combination of DE+T2 was almost similar in both groups on the acute scans (atrial fibrillation free, 89±5.4%; recurrences, 92±4.8%) but different on the chronic scans (60±5.7% versus 34±7.3%). Conclusions-The higher T2 signal on acute scans and greater decline in DE on chronic imaging in patients with recurrences suggest that they have more reversible tissue injury, providing a potential mechanism for pulmonary vein reconnection, resulting in arrhythmia recurrence. (Circ Arrhythm Electrophysiol. 2012;5:691-700.)

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Section: Atrial Scar and Arrhythmia Recurrencementioning

confidence: 99%

Acute Pulmonary Vein Isolation Is Achieved by a Combination of Reversible and Irreversible Atrial Injury After Catheter Ablation

Arujuna

Karim

Caulfield

et al. 2012

Circ: Arrhythmia and Electrophysiology

121

107

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show abstract

“…If PV ostia are completely encircled by a scar, the recurrence of AF is low (Fig. 13) [74]. However, this is difficult to achieve, with only 7% of the patients having complete scarring of all veins in one study [75].…”

Section: Dmentioning

confidence: 99%

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

Jung

2017

Cardiovasc Imaging Asia

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“…Proposed explanations have included elimination of sites of AF wavelet reentry, containment of high-frequency sources, alterations in autonomic input into the atria, or simply debulking of the atrial substrate. 6,11,13,15,16 The lack of specificity of CFAEs does remain a concern. Furthermore, there is a considerable failure rate to achieve sinus rhythm.…”

Section: Article See P 143mentioning

confidence: 99%

Complex Fractionated Atrial Electrograms

Latchamsetty

Morady

2011

Circ: Arrhythmia and Electrophysiology

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Magnetic Resonance Imaging‐Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience

Cited by 88 publications

References 42 publications

Acute Pulmonary Vein Isolation Is Achieved by a Combination of Reversible and Irreversible Atrial Injury After Catheter Ablation

Acute Pulmonary Vein Isolation Is Achieved by a Combination of Reversible and Irreversible Atrial Injury After Catheter Ablation

The Role of Multimodality Cardiac Imaging in the Management of Patients with Atrial Fibrillation

Complex Fractionated Atrial Electrograms

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