Magnetic resonance imaging pre and post pulmonary vein isolation for atrial fibrillation: diagnostic accuracy to detect and characterize ablation lesions Academic research paper on "Veterinary science"

Jones et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):P207

http://www.jcmr-online.com/content/14/S1/P207 \ Journal Of CardiOVaSClllar

Magnetic Resonance

POSTER PRESENTATION Open Access

Magnetic resonance imaging pre and post pulmonary vein isolation for atrial fibrillation: diagnostic accuracy to detect and characterize ablation lesions

Daniel A Jones1*, Ross J Hunter1, Redha Boubertakh1, Louisa Malcolme-Lawes2, Prapa Kanagaratnam2,

7 7 11 11 1

Nicholas S Peters , Christoph Juli , Victoria Baker, Mark Earley , Simon Sporton , Ceri Davies , Mark Westwood , Richard J Schilling1, Steffen E Petersen1

From 15th Annual SCMR Scientific Sessions Orlando, FL, USA. 2-5 February 2012

Summary

LGE imaging of left atrial scar is promising and can detect pre/post ablation procedures however further quality control required to accurately depict lesion distribution

Background

We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of ablation lesions by blinded analysis of pre and post ablation imaging.

Methods

Consecutive patients with paroxysmal AF in a randomised study comparing pulmonary vein isolation by wide area circumferential radiofrequency ablation (WACA) to ostial ablation with a cryo-balloon (CRYO) underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months post ablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface (thresholding set at 5 SD above mean ventricular signal). Scans were categorised using both assessment techniques separately as pre or post ablation, and if post ablation, whether lesions were in an ostial or WACA distribution.

1NIHR Cardiovascular BiomedicalResearch Unit, Barts and the London NHS Trust, London, UK

Full list of author information is available at the end of the article

O© 2012 Jones et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons CGntfäl Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Results

LGE imaging was performed in 50 patients (aged 61 ± 10 years, 72% male). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging, or 88% and 82% respectively on 3D fusion imaging. Detection of WACA and CRYO lesion sets were correct in 14/24 and 16/26 respectively on LGE imaging, or 21/24 and 23/26 on 3D fusion imaging. Assessment of lesion distribution was correct for 13/50 from LGE images (4/24 for WACA and 9/26 for CRYO) and 26/50 from 3D fusion images (p = 0.013; 13/24 for WACA and 13/26 for CRYO).

Conclusions

LGE imaging of atrial scar after ablation therapy is feasible. The technique still needs quality control standards established in order to determine the appropriate SD setting and to judge whether lack of peri-ostial scar is due to a sub-optimal scan or myocardial recovery

Funding

National Institute of Health Research (UK). Author details

1 NIHR Cardiovascular BiomedicalResearch Unit, Barts and the London NHS Trust, London, UK. 2InternationalCentre for Circulatory Health, St Marys Hospital, ImperialCollege Healthcare NHS Trust., London, UK.

Published: 1 February 2012

Jones et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):P207 http://www.jcmr-online.com/content/14/S1/P207

Page 2 of 2

Table 1 Diagnostic accuracy of detecting atrial scarring in blinded analysis of pre and post ablation MR images.

Sensitivity Specificity PPV NPV (%) (%) (%) (%)

Late Gadolinium 60 96 94 68

Enhancement

Segmented Fusion images 88 82 81 87

Table 2 Accuracy of MR images to locate atrial scarring according to ablation technique

Correct identification of lesion distribution

Fusion segmented image

4/24 (17%) 9/26 (35%)

13/24 (54%) 13/26 (50%)

doi:10.1186/1532-429X-14-S1-P207

Cite this article as: Jones et al.: Magnetic resonance imaging pre and post pulmonary vein isolation for atrial fibrillation: diagnostic accuracy to detect and characterize ablation lesions. Journal of Cardiovascular Magnetic Resonance 2012 14(Suppl 1):P207.

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