Advertisement

Prospective evaluation of left atrial function and late gadolinium enhancement with 3 T MRI in patients with atrial fibrillation before and after catheter ablation

  • Adrian CurtaEmail author
  • Stephanie Fichtner
  • Reza Wakili
  • Heidi Estner
  • Harald Kramer
Original Paper

Abstract

In a prospective, randomized study we performed left atrial (LA) functional imaging and late gadolinium enhancement (LGE) in patients undergoing pulmonary vein isolation with ablation of the anterior mitral line to evaluate LA function and visibility of the anterior mitral line and to explore the relationship of these factors to short- and long-term procedural success. Functional imaging of the LA and LGE-visualization 15 min post i.v. administration of gadobutrol was performed on a 3 T MRI system before and after ablation. Patients were grouped in (a) subjects with sinus rhythm, and (b) subjects without sinus rhythm at the follow-up-MRI. Eight patients were excluded due to poor image quality. 37 patients were allotted to group a, 4 patients to group b. Group a showed a significant improvement in ejection fraction (22.3 ± 7.1% vs. 27.2 ± 5.5%; p < 0.001), end-systolic volume (111.6 ± 48.3 ml vs. 96.9 ± 37.2 ml; p = 0.002), stroke volume (30.2 ± 12.6 ml vs. 35.6 ± 12.6 ml; p = 0.003) and LGE (12.5% vs. 83.7%; p < 0.001). Group b showed no significant changes in functional parameters or LGE. Patients with successful therapy at 12 months showed significantly lower volumes in the baseline MRI. Scarring along the ablation pathways could be visualized with LGE. Patients with successful CA showed a significant improvement in LA cardiac parameters. Pre-ablation atrial volume seems to be a predictor for long-term success.

Keywords

Cardiac MRI Atrial function Catheter ablation Scarring Anterior mitral line Gadolinium late enhancement Atrial fibrillation 

Notes

Compliance with ethical standards

Conflict of interest

Heidi Estner receives an investigator-initiated grant by Biosense Webster, holds honorary lectures for Boehringer Ingelheim Boston and is an advisory for Boston Scientific. The other authors declare that they have no potential conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Chugh SS, Havmoeller R, Narayanan K et al (2014) Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129(8):837–847CrossRefGoogle Scholar
  2. 2.
    Ferrari R, Bertini M, Blomstrom-Lundqvist C et al (2016) An update on atrial fibrillation in 2014: from pathophysiology to treatment. Int J Cardiol 203:22–29CrossRefGoogle Scholar
  3. 3.
    Kirchhof P, Lip GY, Van Gelder IC et al (2014). Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options–a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference. Europace 14(1):8–27CrossRefGoogle Scholar
  4. 4.
    Fichtner S, Sparn K, Reents T et al (2015) Recurrence of paroxysmal atrial fibrillation after pulmonary vein isolation: is repeat pulmonary vein isolation enough? A prospective, randomized trial. Europace 17(9):1371–1375CrossRefGoogle Scholar
  5. 5.
    Sandstede JJ, Lipke C, Beer M et al (2000) Analysis of first-pass and delayed contrast-enhancement patterns of dysfunctional myocardium on MR imaging: use in the prediction of myocardial viability. AJR Am J Roentgenol 174(6):1737–1740CrossRefGoogle Scholar
  6. 6.
    Setser RM, Bexell DG, O’Donnell TP et al (2003) Quantitative assessment of myocardial scar in delayed enhancement magnetic resonance imaging. J Magn Reson Imaging 18(4):434–441CrossRefGoogle Scholar
  7. 7.
    Oakes RS, Badger TJ, Kholmovski EG et al (2009) Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 119(13):1758–1767CrossRefGoogle Scholar
  8. 8.
    McGann CJ, Kholmovski EG, Oakes RS et al (2008) New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol 52(15):1263–1271CrossRefGoogle Scholar
  9. 9.
    Higuchi K, Akkaya M, Akoum N, Marrouche NF (2014) Cardiac MRI assessment of atrial fibrosis in atrial fibrillation: implications for diagnosis and therapy. Heart (Br Card Soc) 100(7):590–596Google Scholar
  10. 10.
    Peters DC, Wylie JV, Hauser TH et al (2007) Detection of pulmonary vein and left atrial scar after catheter ablation with three-dimensional navigator-gated delayed enhancement MR imaging: initial experience. Radiology 243(3):690–695CrossRefGoogle Scholar
  11. 11.
    Hunter RJ, Jones DA, Boubertakh R et al (2013) Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience. J Cardiovasc Electrophysiol 24(4):396–403CrossRefGoogle Scholar
  12. 12.
    Beukema WP, Elvan A, Sie HT, Misier AR, Wellens HJ (2005) Successful radiofrequency ablation in patients with previous atrial fibrillation results in a significant decrease in left atrial size. Circulation 112(14):2089–2095CrossRefGoogle Scholar
  13. 13.
    Muller H, Noble S, Keller PF et al (2008) Biatrial anatomical reverse remodelling after radiofrequency catheter ablation for atrial fibrillation: evidence from real-time three-dimensional echocardiography. Europace 10(9):1073–1078CrossRefGoogle Scholar
  14. 14.
    Sallach SM, Peshock RM, Reimold S (2007) Noninvasive cardiac imaging in pulmonary hypertension. Cardiol Rev 15(2):97–101CrossRefGoogle Scholar
  15. 15.
    Jahnke C, Fischer J, Gerds-Li JH et al (2011) Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: a magnetic resonance imaging study. Int J Cardiol 153(1):42–46CrossRefGoogle Scholar
  16. 16.
    Khan IA (2003) Atrial stunning: basics and clinical considerations. International J Cardiol 92(2–3):113–128CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Radiology, University HospitalLMU MunichMunichGermany
  2. 2.Medizinische Klinik und Poliklinik I, University HospitalLMU MunichMunichGermany
  3. 3.Clinic for Cardiology and AngiologyUniversity Hospital EssenEssenGermany

Personalised recommendations