Dataset Information

MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation.

ABSTRACT: Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF.Seventeen patients with AF underwent initial pulmonary vein (PV) isolation (PVI) using RF (n = 7), Cryo (n = 5), and Laser (n = 5). LGE-MRI was performed prior to and at 24 hours and 3 months after PVI.In a linear mixed-effects model, accounting for intrapatient clustering of data and interpatient differences in baseline scar, LGE extent was significantly increased at 24 hours postablation (+14.6 ± 1.9% of LA myocardium, P < 0.001), and remained stable from 24 hours to 3 months (+0.12 ± 1.9%, P = 0.951). There was no statistically significant difference between the postablation scar extent among ablation modalities when compared to RF (Cryo +4.5 ± 3.0%, P = 0.123; Laser -3.2 ± 3.0%, P = 0.291). The PV antral LGE intensity was increased by 25.1 ± 3.8% (P<0.001) 24 hours after ablation and additionally increased by 8.1 ± 3.8 at 3 months (P = 0.033).Radiofrequency, Cryo, and laser ablation result in increased LGE extent and intensity at 24 hours and 3 months postablation. No statistically significant difference was noted in the extent of fibrosis induced by any modality.

SUBMITTER: Khurram IM

PROVIDER: S-EPMC4624567 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Publications

MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation.

Khurram Irfan M IM Catanzaro John N JN Zimmerman Stefan S Zipunnikov Vadim V Berger Ronald D RD Cheng Alan A Sinha Sunil S Dewire Jane J Marine Joseph J Spragg David D Ashikaga Hiroshi H Halperin Henry H Calkins Hugh H Nazarian Saman S

Pacing and clinical electrophysiology : PACE 20150817 11

<h4>Background</h4> Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF.< ...[more]

PMID: 26171648

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Project description:Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is the cornerstone of atrial fibrillation (AF) therapy, but few strategies exist for when it fails. To guide RFA, phase singularity (PS) mapping locates reentrant electrical waves (rotors) that perpetuate AF. The goal of this study was to test existing and develop new RFA strategies for terminating rotors identified with PS mapping. It is unsafe to test experimental RFA strategies in patients, so they were evaluated in silico using a bilayer computer model of the human atria with persistent AF (pAF) electrical (ionic) and structural (fibrosis) remodeling. pAF was initiated by rapidly pacing the right (RSPV) and left (LSPV) superior pulmonary veins during sinus rhythm, and rotor dynamics quantified by PS analysis. Three RFA strategies were studied: (i) PVI, roof, and mitral lines; (ii) circles, perforated circles, lines, and crosses 0.5-1.5 cm in diameter/length administered near rotor locations/pathways identified by PS mapping; and (iii) 4-8 lines streamlining the sequence of electrical activation during sinus rhythm. As in pAF patients, 2 ± 1 rotors with cycle length 185 ± 4 ms and short PS duration 452 ± 401 ms perpetuated simulated pAF. Spatially, PS density had weak to moderate positive correlations with fibrosis density (RSPV: r = 0.38, p = 0.35, LSPV: r = 0.77, p = 0.02). RFA PVI, mitral, and roof lines failed to terminate pAF, but RFA perforated circles and lines 1.5 cm in diameter/length terminated meandering rotors from RSPV pacing when placed at locations with high PS density. Similarly, RFA circles, perforated circles, and crosses 1.5 cm in diameter/length terminated stationary rotors from LSPV pacing. The most effective strategy for terminating pAF was to streamline the sequence of activation during sinus rhythm with >4 RFA lines. These results demonstrate that co-localizing 1.5 cm RFA lesions with locations of high PS density is a promising strategy for terminating pAF rotors. For patients immune to PVI, roof, mitral, and PS guided RFA strategies, streamlining patient-specific activation sequences during sinus rhythm is a robust but challenging alternative.

Dataset Information

MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation.

Publications

MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation.

Similar Datasets

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