Author + information
- Felipe Bisbal,
- Esther Guiu,
- Antonio Berruezo,
- Pilar Cabanas,
- Susana Prat-Gonzalez,
- Cesar Garrido,
- David Andreu,
- Juan Fernandez-Armenta,
- Barbara Vidal,
- Teresa M. Caralt,
- Josep Brugada and
- Lluis Mont
The presence of gaps in prior pulmonary vein (PV) isolation (PVI) ablation lesions may be the cause of procedural failure. Delayed-enhanced (DE) cardiac magnetic resonance (CMR) allows the identification of radiofrequency (RF) lesions and gaps (CMR gaps). The present study aimed to test the usefulness of a new DE-CMR guided approach to ablate gaps in repeat procedures.
A 3D DE-CMR volume-rendered left atrial reconstruction (3D model) was created after manually segmenting endocardium and epicardium. The pixel signal intensity map was projected on the 3D model and color-coded. The 3D model was then imported into the navigation system. RF was delivered targeting the CMR gaps, blinded to electrical data.
A series of 6 patients were included (61±7 years, 50% with paroxysmal AF, mean time from prior PVI of 17±7 months). 3 patients had additional roof line. In total, 37 CMR gaps were identified around 22 PVs and 7 at the roof line, with a mean of 7.3 gaps/patient and a mean gap length of 6.3 mm. 18/22 PVs were electrically reconnected (mean of 3/patient). All reconnected PVs presented CMR gaps, with electrical-CMR concordance of 94%. Guided by the 3D model, isolation of all PVs was achieved after a mean of 2.8±1.8 RF applications/gap (18.2±10.5/patient) and 124±86 seconds/gap (869±730 seconds/patient).
DE-CMR is a useful tool to guide the repeat PVI procedure by accurately identifying and locating the gaps, with the potential of reducing procedure duration and RF application time.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: AF/SVT VII
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1236-35
- 2013 American College of Cardiology Foundation