PMID- 21718914
OWN - NLM
STAT- MEDLINE
DCOM- 20110906
LR  - 20211020
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 58
IP  - 2
DP  - 2011 Jul 5
TI  - Dark regions of no-reflow on late gadolinium enhancement magnetic resonance 
      imaging result in scar formation after atrial fibrillation ablation.
PG  - 177-85
LID - 10.1016/j.jacc.2011.04.008 [doi]
AB  - OBJECTIVES: The aim of this study was to assess acute ablation injuries seen on 
      late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) immediately 
      post-ablation (IPA) and the association with permanent scar 3 months 
      post-ablation (3moPA). BACKGROUND: Success rates for atrial fibrillation catheter 
      ablation vary significantly, in part because of limited information about the 
      location, extent, and permanence of ablation injury at the time of procedure. 
      Although the amount of scar on LGE MRI months after ablation correlates with 
      procedure outcomes, early imaging predictors of scar remain elusive. METHODS: 
      Thirty-seven patients presenting for atrial fibrillation ablation underwent 
      high-resolution MRI with a 3-dimensional LGE sequence before ablation, IPA, and 
      3moPA using a 3-T scanner. The acute left atrial wall injuries on IPA scans were 
      categorized as hyperenhancing (HE) or nonenhancing (NE) and compared with scar 
      3moPA. RESULTS: Heterogeneous injuries with HE and NE regions were identified in 
      all patients. Dark NE regions in the left atrial wall on LGE MRI demonstrate 
      findings similar to the "no-reflow" phenomenon. Although the left atrial wall 
      showed similar amounts of HE, NE, and normal tissue IPA (37.7 +/- 13%, 34.3 +/- 14%, 
      and 28.0 +/- 11%, respectively; p = NS), registration of IPA injuries with 3moPA 
      scarring demonstrated that 59.0 +/- 19% of scar resulted from NE tissue, 30.6 +/- 15% 
      from HE tissue, and 10.4 +/- 5% from tissue identified as normal. Paired t-test 
      comparisons were all statistically significant among NE, HE, and normal tissue 
      types (p < 0.001). Arrhythmia recurrence at 1-year follow-up correlated with the 
      degree of wall enhancement 3moPA (p = 0.02). CONCLUSIONS: Radiofrequency ablation 
      results in heterogeneous injury on LGE MRI with both HE and NE wall lesions. The 
      NE lesions demonstrate no-reflow characteristics and reveal a better predictor of 
      final scar at 3 months. Scar correlates with procedure outcomes, further 
      highlighting the importance of early scar prediction.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - McGann, Christopher
AU  - McGann C
AD  - Comprehensive Arrhythmia Research and Management Center, University of Utah, Salt 
      Lake City, Utah 84132, USA. chris.mcgann@hsc.utah.edu
FAU - Kholmovski, Eugene
AU  - Kholmovski E
FAU - Blauer, Joshua
AU  - Blauer J
FAU - Vijayakumar, Sathya
AU  - Vijayakumar S
FAU - Haslam, Thomas
AU  - Haslam T
FAU - Cates, Joshua
AU  - Cates J
FAU - DiBella, Edward
AU  - DiBella E
FAU - Burgon, Nathan
AU  - Burgon N
FAU - Wilson, Brent
AU  - Wilson B
FAU - Alexander, Alton
AU  - Alexander A
FAU - Prastawa, Marcel
AU  - Prastawa M
FAU - Daccarett, Marcos
AU  - Daccarett M
FAU - Vergara, Gaston
AU  - Vergara G
FAU - Akoum, Nazem
AU  - Akoum N
FAU - Parker, Dennis
AU  - Parker D
FAU - MacLeod, Rob
AU  - MacLeod R
FAU - Marrouche, Nassir
AU  - Marrouche N
LA  - eng
GR  - U54 EB005149/EB/NIBIB NIH HHS/United States
GR  - 2P41 RR0112553-12/RR/NCRR NIH HHS/United States
GR  - P41 RR012553/RR/NCRR NIH HHS/United States
GR  - P41 GM103545/GM/NIGMS NIH HHS/United States
GR  - P41-RR12553-10/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Contrast Media)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
MH  - Atrial Fibrillation/*therapy
MH  - Cardiology/*methods
MH  - Catheter Ablation
MH  - Cicatrix/pathology
MH  - Cohort Studies
MH  - Contrast Media/pharmacology
MH  - Diagnostic Imaging/methods
MH  - Electrophysiology/methods
MH  - Gadolinium/*pharmacology
MH  - Heart Atria/pathology
MH  - Humans
MH  - Image Processing, Computer-Assisted/methods
MH  - Kinetics
MH  - Magnetic Resonance Imaging/*methods
MH  - Observer Variation
MH  - Reproducibility of Results
PMC - PMC3746015
MID - NIHMS455319
EDAT- 2011/07/02 06:00
MHDA- 2011/09/07 06:00
PMCR- 2013/08/18
CRDT- 2011/07/02 06:00
PHST- 2011/01/04 00:00 [received]
PHST- 2011/03/18 00:00 [revised]
PHST- 2011/04/19 00:00 [accepted]
PHST- 2011/07/02 06:00 [entrez]
PHST- 2011/07/02 06:00 [pubmed]
PHST- 2011/09/07 06:00 [medline]
PHST- 2013/08/18 00:00 [pmc-release]
AID - S0735-1097(11)01399-4 [pii]
AID - 10.1016/j.jacc.2011.04.008 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Jul 5;58(2):177-85. doi: 10.1016/j.jacc.2011.04.008.