Noninvasive assessment of durability of ablation lesions with magnetic resonance imaging: Are we there yet?

Gupta, Dhiraj

doi:10.1111/jce.14661

Cited by 1 publication

(2 citation statements)

References 12 publications

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“…Against this background, in most centres clinically relevant AF recurrences almost automatically trigger repeat ablation procedures aiming at PV re-isolation. 2 , 3 However, technological and procedural advances have substantially improved efficacy of catheter ablation. 4–10 As a result, it is becoming increasingly common to find all four PVs isolated in those repeat procedures.…”

Section: Introductionmentioning

confidence: 99%

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Non-invasive assessment of pulmonary vein isolation durability using late gadolinium enhancement magnetic resonance imaging

Padilla-Cueto¹,

Ferró²,

Garre³

et al. 2022

EP Europace

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Aims Electrical reconnection of pulmonary veins (PVs) is considered an important determinant of recurrent atrial fibrillation (AF) after pulmonary vein isolation (PVI). To date, AF recurrences almost automatically trigger invasive repeat procedures, required to assess PVI durability. With recent technical advances, it is becoming increasingly common to find all PVs isolated in those repeat procedures. Thus, as ablation of extra-PV targets has failed to show benefit in randomized trials, more and more often these highly invasive procedures are performed only to rule out PV reconnection. Here we aim to define the ability of late gadolinium enhancement (LGE)-magnetic resonance imaging (MRI) to rule out PV reconnection non-invasively. Methods and results This study is based on a prospective registry in which all patients receive an LGE-MRI after AF ablation. Included were all patients that—after an initial PVI and post-ablation LGE-MRI—underwent an invasive repeat procedure, which served as a reference to determine the predictive value of non-invasive lesion assessment by LGE-MRI.: 152 patients and 304 PV pairs were analysed. LGE-MRI predicted electrical PV reconnection with high sensitivity (98.9%) but rather low specificity (55.6%). Of note, LGE lesions without discontinuation ruled out reconnection of the respective PV pair with a negative predictive value of 96.9%, and patients with complete LGE lesion sets encircling all PVs were highly unlikely to show any PV reconnection (negative predictive value: 94.4%). Conclusion LGE-MRI has the potential to guide selection of appropriate candidates and planning of the ablation strategy for repeat procedures and may help to identify patients that will not benefit from a redo-procedure if no ablation of extra-PV targets is intended.

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Section: Introductionmentioning

confidence: 99%

“… 11 Thus, as ablation of extra-PV targets has failed to show benefit in large randomized trials, more and more often these highly invasive procedures are being performed only to confirm durable PVI. 3 …”

Section: Introductionmentioning

confidence: 99%