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DOI: 10.1148/radiol.2433060417
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Detection of Pulmonary Vein and Left Atrial Scar after Catheter Ablation with Three-dimensional Navigator-gated Delayed Enhancement MR Imaging: Initial Experience1

Dana C. Peters, PhD, John V. Wylie, MD, Thomas H. Hauser, MD, Kraig V. Kissinger, RT, René M. Botnar, PhD2, Vidal Essebag, MD, PhD, Mark E. Josephson, MD, and Warren J. Manning, MD

1 From the Department of Medicine, Cardiovascular Division (D.C.P., J.V.W., T.H.H., K.V.K., R.M.B., V.E., M.E.J., W.J.M.) and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RW 453, Boston, MA 02215. Received March 6, 2006; revision requested May 4; revision received June 21; accepted July 20; final version accepted September 27. Supported by grants from the American Heart Association (AHA SDG 0530061N) and the National Institutes of Health (NIBIB K01 EB004434-01A1). V.E. received a Clinician Scientist Award from the Canadian Institutes of Health Research. Address correspondence to D.C.P. (e-mail: dcpeters{at}bidmc.harvard.edu).


Figure 1
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  		Figure 1: Transverse, A, contrast-enhanced MR angiographic images and inversion-recovery gradient-echo, B, preablation and, C, postablation delayed enhancement matched MR images (4.3/2.1; flip angle, 15°; field of view, 30 x 30 x 12.5 cm; voxel size, 1.3 x 1.3 x 5 mm) acquired more than 30 days after ablation in three patients with AF. The MR angiographic image provides anatomic context. Delayed enhancement is not observed before ablation (arrows in B) but is readily observed after ablation (arrows in C). LIPV = left inferior PV, LSPV = left superior PV, RIPV = right inferior PV, RSPV = right superior PV.

 

Figure 2
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  		Figure 2: Left: Electroanatomic map of the RF ablation sites (red spheres) applied to the common ostium of the left PV in one patient. Color map indicates the measured potentials around the LA before ablation (red = low voltage). Top right: Reformatted 10-mm maximum intensity projection of the three-dimensional delayed enhancement MR image displays the ablation ring of the left PV. Arrows indicate correspondence between the ablation patterns in the two modalities, with less delayed enhancement corresponding to an area of fewer ablation sites (white arrows). Bottom right: Vertical slab indicates sagittal prescription of the reformatted image.

 

Figure 3
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  		Figure 3: Graph shows scar thinning demonstrated by comparing delayed enhancement (ie, scar) thickness with the inverse of the number of days after the ablation procedure. The relationship between thickness and the inverse of the number of days after ablation was significant (thickness = 1.87 + 43.03[1/d] and P = .005, shown with the regression line).

 




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