PMID- 29530833 OWN - NLM STAT- MEDLINE DCOM- 20190219 LR - 20220410 IS - 1556-3871 (Electronic) IS - 1547-5271 (Print) IS - 1547-5271 (Linking) VI - 15 IP - 8 DP - 2018 Aug TI - Visualization of acute edema in the left atrial myocardium after radiofrequency ablation: Application of a novel high-resolution 3-dimensional magnetic resonance imaging sequence. PG - 1189-1197 LID - S1547-5271(18)30213-3 [pii] LID - 10.1016/j.hrthm.2018.03.010 [doi] AB - BACKGROUND: Ablation-induced left atrial (LA) edema may result in procedural failure due to reversible pulmonary vein isolation. Conventional T2-weighted magnetic resonance edema imaging is limited by low spatial resolution. OBJECTIVE: The purpose of this pilot study was to optimize and validate a 3-dimensional (3D) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) sequence for quantification of T2 signal in the LA, and to apply it in recently ablated patients, comparing myocardial edema on T2-SPACE to tissue damage on late gadolinium enhancement (LGE) imaging. METHODS: Phantom studies were performed to identify 3D-SPACE parameters for optimal contrast between normal and edematous myocardium. Fourteen AF patients were imaged with both 3D-SPACE and dark-blood turbo-spin echo (DB-TSE) to compare image quality and signal intensity between the 2 techniques. Eight patients underwent pre- and postablation 3D-SPACE and 3D-LGE imaging. Ablation points were co-registered with corresponding myocardial sectors, and ablation-induced changes in T2 and LGE signal intensities were measured. RESULTS: Signal-to-noise ratio and contrast-to-noise ratio were higher on SPACE vs DB-TSE (65.5 +/- 33.9 vs 35.7 +/- 17.9; P = .01; and 59.4 +/- 33.0 vs 32.9 +/- 17.7; P = .04, respectively). T2-signal correlated well on 3D-SPACE and DB-TSE, such that each unit increase in TSE intensity correlated with a 0.69-unit increase in SPACE intensity (95% confidence interval 0.56-0.82; P <.001). T2 and LGE signal intensities were acutely increased at ablation sites. The extent of postablation edema was higher compared to LGE, although the spatial distribution of hyperenhancement around pulmonary veins seemed similar in both modalities. CONCLUSION: T2-SPACE can be used to map the extent of acute postablation edema in the thin LA myocardium, with improved resolution and lower artifact compared to traditional DB-TSE. CI - Copyright (c) 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. FAU - Zghaib, Tarek AU - Zghaib T AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tarek.z@jhmi.edu. FAU - Malayeri, Ashkan A AU - Malayeri AA AD - Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland. FAU - Ipek, Esra G AU - Ipek EG AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Habibi, Mohammadali AU - Habibi M AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Huang, Dong AU - Huang D AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Balouch, Muhammad A AU - Balouch MA AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Bluemke, David A AU - Bluemke DA AD - Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland. FAU - Calkins, Hugh AU - Calkins H AD - Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Nazarian, Saman AU - Nazarian S AD - Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. FAU - Zimmerman, Stefan L AU - Zimmerman SL AD - Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. LA - eng GR - K23 HL089333/HL/NHLBI NIH HHS/United States GR - R01 HL116280/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Validation Study DEP - 20180309 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 SB - IM MH - Acute Disease MH - Adult MH - Aged MH - Aged, 80 and over MH - Atrial Fibrillation/physiopathology/*surgery MH - Catheter Ablation/*adverse effects MH - Edema/*diagnosis/etiology MH - Female MH - Heart Atria/*diagnostic imaging MH - Heart Conduction System/physiopathology/surgery MH - Humans MH - Imaging, Three-Dimensional/*methods MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Myocardium/*pathology MH - Pilot Projects PMC - PMC6067985 MID - NIHMS950555 OTO - NOTNLM OT - Atrial fibrillation OT - Late gadolinium enhancement OT - Left atrial edema OT - Left atrial fibrosis OT - Left atrial imaging OT - Radiofrequency ablation OT - T2-weighted imaging COIS- Conflict of interests- Dr. Nazarian has received research grant funding from Biosense Webster during the conduct of the study. All other authors have no relationships relevant to the contents of this paper to disclose. EDAT- 2018/03/14 06:00 MHDA- 2019/03/21 06:00 PMCR- 2019/08/01 CRDT- 2018/03/14 06:00 PHST- 2018/01/10 00:00 [received] PHST- 2018/03/14 06:00 [pubmed] PHST- 2019/03/21 06:00 [medline] PHST- 2018/03/14 06:00 [entrez] PHST- 2019/08/01 00:00 [pmc-release] AID - S1547-5271(18)30213-3 [pii] AID - 10.1016/j.hrthm.2018.03.010 [doi] PST - ppublish SO - Heart Rhythm. 2018 Aug;15(8):1189-1197. doi: 10.1016/j.hrthm.2018.03.010. Epub 2018 Mar 9.