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Comparative Study
. 2014 May;25(5):457-463.
doi: 10.1111/jce.12357. Epub 2014 Jan 24.

Comparison of left atrial area marked ablated in electroanatomical maps with scar in MRI

Bhrigu R Parmar  1 , Tyler R Jarrett  1 , Nathan S Burgon  1 , Eugene G Kholmovski  1 , Nazem W Akoum  1 , Nan Hu  2 , Rob S Macleod  1 , Nassir F Marrouche  1 , Ravi Ranjan  1
Affiliations
Comparative Study

Comparison of left atrial area marked ablated in electroanatomical maps with scar in MRI

Bhrigu R Parmar et al. J Cardiovasc Electrophysiol. 2014 May.

Abstract

Background: Three-dimensional electroanatomic mapping (EAM) is routinely used to mark ablated areas during radiofrequency ablation. We hypothesized that, in atrial fibrillation (AF) ablation, EAM overestimates scar formation in the left atrium (LA) when compared to the scar seen on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI).

Methods and results: Of the 235 patients who underwent initial ablation for AF at our institution between August 2011 and December 2012, we retrospectively identified 70 patients who had preprocedural magnetic resonance angiography merged with LA anatomy in EAM software and had a 3-month postablation LGE-MRI for assessment of scar. Ablated area was marked intraprocedurally using EAM software and quantified retrospectively. Scarred area was quantified in 3-month postablation LGE-MRI. The mean ablated area in EAM was 30.5 ± 7.5% of the LA endocardial surface and the mean scarred area in LGE-MRI was 13.9 ± 5.9% (P < 0.001). This significant difference in the ablated area marked in the EAM and scar area in the LGE-MRI was present for each of the 3 independent operators. Complete pulmonary vein (PV) encirclement representing electrical isolation was observed in 87.8% of the PVs in EAM as compared to only 37.4% in LGE-MRI (P < 0.001).

Conclusions: In AF ablation, EAM significantly overestimates the resultant scar as assessed with a follow-up LGE-MRI.

Keywords: atrial fibrillation; magnetic resonance imaging; radiofrequency ablation.

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Figures

Figure 1
Figure 1
Measurement of ablated area in EAM. Ablation tags (red) are projected onto the surface of the LA model (green). Lines were drawn on the surface of the model to define the PV ostia (yellow), ablated regions (white), and gaps in ablated regions (blue). Gaps and PV surface area were measured and subtracted from surface area enclosed by white contours to derive ablated surface area. EAM: electroanatomic mapping; LA: left atrium; PV: pulmonary vein.
Figure 2
Figure 2
Comparison of the mean ablated area along with corresponding standard deviation in EAM and three-month LGE-MRI for all patient (p<0.001). EAM: electroanatomic mapping; LGE-MRI: late-gadolinium enhancement magnetic resonance imaging.
Figure 3
Figure 3
Comparison of PVI in EAM and follow-up LGE-MRI in two patients. The upper rows show a close correlation between ablation tags marked in EAM (row 1) with corresponding scar in follow-up LGE-MRI (row 2). The difference between ablated and scarred areas was 5.3 %. Rows 3 and 4 demonstrate a much greater difference (30.6 %) between EAM and LGE-MRI areas. EAM: electroanatomic mapping; LGE-MRI: late-gadolinium enhancement magnetic resonance imaging; PVI: pulmonary vein isolation; AP: antero-posterior; PA: postero-anterior; RPO: right posterior oblique; LPO: Left posterior oblique, LL: left lateral.
Figure 4
Figure 4
Comparison of mean percent encirclement of each PV in EAM and scar from LGE-MRI (p-values <0.001 for each PV comparison). EAM: electroanatomic mapping; LGE-MRI: late-gadolinium enhancement magnetic resonance imaging; LSPV: left superior pulmonary vein; LIPV: left inferior pulmonary vein; RSPV: right superior pulmonary vein; RIPV: right inferior pulmonary vein.
Figure 5
Figure 5
Comparison of completely encircled PVs with ablation tags in EAM and scar in LGE-MRI. Complete encirclement defined as >90% encirclement of the PVs by ablation tags or scar. Differences were significant for all four vein pairs (p< 0.001). EAM: electroanatomic mapping; LGE-MRI: late-gadolinium enhancement magnetic resonance imaging; LSPV: left superior pulmonary vein; LIPV: left inferior pulmonary vein; RSPV: right superior pulmonary vein; RIPV: right inferior pulmonary vein.
Figure 6
Figure 6
Comparison of mean ablated area along with corresponding standard deviation in EAM and in LGE-MRI for each operator (p<0.01). Means are presented in columns with standard deviation bars. LA: left atrium; EAM: electroanatomic mapping; LGE-MRI: late-gadolinium enhancement magnetic resonance imaging.
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