Visualization of intensive atrial inflammation and fibrosis after cryoballoon ablation: PET/MRI and LGE‐MRI analysis

Kiuchi, Kunihiko; Fukuzawa, Koji; Nogami, Munenobu; Watanabe, Yoshiaki; Takami, Mitsuru; Izawa, Yu; Negi, Noriyuki; Kyotani, Katsusuke; Mori, Shigeo; Hirata, Ken‐ichi

doi:10.1002/joa3.12454

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…Therefore, we speculate that insufficient cryo-lesion, which could be presented as lower inflammation, might be responsible for PV reconnection or reactivation of pro-arrhythmic matrix during the early phase of post-CBA. By assessment of PET/MRI, Kiuchi found that CBA induced atrial inflammation was strongly associated with lesion maturation, which could be important to the ablation success [ 17 ]. Since the inflammation after AF ablation is double-edged, optimal inflammation could consolidate the ablation lesion while lower inflammation may unmask lesion gap and consequently lead to early recurrence.…”

Section: Discussionmentioning

confidence: 99%

Early recurrence after cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: mechanism and implication in long-term outcome

Yue

Bao

Lin

et al. 2022

BMC Cardiovasc Disord

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Background Early recurrence (ER) after catheter ablation for atrial fibrillation (AF) has been considered as a common phenomenon but its mechanism and implication in long-term outcome has not been fully elucidated. We aimed to clarify the relation between post-ablation inflammation and ER after cryoballoon ablation (CBA) or radio-frequency ablation (RFA) and evaluate the clinical significance of ER. Methods A total of 154 patients with paroxysmal AF undergoing ablation were consecutively recruited, including 90 patients undergoing RFA (RF group) and 64 patients undergoing CBA (CB group). Myocardial injury and inflammation biomarkers were analyzed before and 6 h, 24 h and 48 h after ablation. Acute early recurrence (AER), non-acute early recurrence (NAER) and late recurrence (LR) was defined as recurrence of atrial tachyarrhythmia during 0–3, 4–90 days and beyond a 90-day blanking period after ablation. Results Cardiac troponin I was significantly higher in CB group while C reactive protein (CRP) and Ratio Neutrophil/Lymphocyte were more elevated in RF group. Higher CRP level after RFA was significantly associated with AER in RF group and lower CRP level after CBA was predictive of AER in CB group. In addition, average cryoablation duration was positively correlated with CRP level after CB group. Cox regression revealed that NAER and left atrial diameter were associated with LR in RF group, while AER and NAER were predictive of LR after CBA. Conclusions Post-ablation inflammation was greater in RFA than in CBA. Excessive inflammatory response may be an important factor of AER after RFA. AER after CBA was related with lower inflammation and predictive of LR. Further investigations are still warranted to address on these findings.

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Section: Discussionmentioning

confidence: 99%

Early recurrence after cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: mechanism and implication in long-term outcome

Yue

Bao

Lin

et al. 2022

BMC Cardiovasc Disord

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“…It is noteworthy though that LGE is not specific for fibrotic tissue, but can reflect other pathological processes associated with an expansion of the extracellular space such as inflammation and oedema formation, which impedes definite lesion assessment, particularly in the acute setting. [ 34 ]…”

Section: Lge-mri For the Detection Of Ablation-induced Fibrosismentioning

confidence: 99%

Ablation Lesion Assessment with MRI

Mont

Roca‐Luque

Althoff

2022

Arrhythm Electrophysiol Rev

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Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.

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