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Case Reports
. 2016 Aug 15;8(8):e738.
doi: 10.7759/cureus.738.

Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging Post-robotic Radiosurgical Pulmonary Vein Isolation (RRPVI): First Case in the World

Edgar Monroy  1 , Jose Azpiri  2 , Cuauhtémoc De La Peña  3 , Carlos Cardona  3 , Miguel Hinojosa  3 , Rafael Zamarripa  1 , Jose Assad  2
Affiliations
Case Reports

Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging Post-robotic Radiosurgical Pulmonary Vein Isolation (RRPVI): First Case in the World

Edgar Monroy et al. Cureus. .

Abstract

Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF).

Keywords: atrial fibrillation; cardiac magnetic resonance; cardiac radiosurgery; cyberheart; cyberknife; pulmonary vein isolation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Multiplan Review Image Showing Beam Entries, Dose Volume Histogram, and Dose Statistics
Figure 2
Figure 2. Delayed Enhancement Inversion-Recovery Images Before and After Treatment with CyberKnife
2A, 2B, and 2C: Axial 2-dimensional delayed enhancement inversion-recovery images pre-isolation of pulmonary veins. 2D, 2E, and 2F: Axial 2-dimensional delayed enhancement inversion-recovery images acquired one year after isolation of pulmary veins. Delayed enhancement is not observed before ablation but is readily observed after ablation (arrows in 2D, 2E, and 2F).
Figure 3
Figure 3. Echopixel Delayed Enhancement Inversion-Recovery Images After Treatment with CyberKnife
3A, 3B, 3C and 3D: delayed enhancement inversion-recovery images one year after isolation of pulmary veins using Echopixel to highlight the observed findings consistent with fibrosis around pulmonary veins (arrows in 3B and 3C), base of left atrial appendage (arrowhead in 3C), roof of left atrium (arrows in 3A and 3D), and near coronary sinus, subsequent to treatment with CyberKnife.
See this image and copyright information in PMC

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