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Eur Heart J. 2014 Jun 7;35(22):1486-95. doi: 10.1093/eurheartj/eht560. Epub 2014 Jan 12.

Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study.

Author information

1
Division of Imaging Sciences & Biomedical Engineering, Medical Engineering Centre, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, SE1 7EH London, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK james.harrison@kcl.ac.uk.
2
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
3
Division of Imaging Sciences & Biomedical Engineering, Medical Engineering Centre, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, SE1 7EH London, UK.
4
Division of Imaging Sciences & Biomedical Engineering, Medical Engineering Centre, King's College London, 3rd Floor, Lambeth Wing, St Thomas' Hospital, SE1 7EH London, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
5
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby, Aarhus, Denmark MR-Center, Aarhus University Hospital Skejby, Aarhus, Denmark.
6
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark MR-Center, Aarhus University Hospital Skejby, Aarhus, Denmark.
7
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital Skejby, Aarhus, Denmark.
8
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
9
Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.

Abstract

AIMS:

To provide a comprehensive histopathological validation of cardiac magnetic resonance (CMR) and endocardial voltage mapping of acute and chronic atrial ablation injury.

METHODS AND RESULTS:

16 pigs underwent pre-ablation T2-weighted (T2W) and late gadolinium enhancement (LGE) CMR and high-density voltage mapping of the right atrium (RA) and both were repeated after intercaval linear radiofrequency ablation. Eight pigs were sacrificed following the procedure for pathological examination. A further eight pigs were recovered for 8 weeks, before chronic CMR, repeat RA voltage mapping and pathological examination. Signal intensity (SI) thresholds from 0 to 15 SD above a reference SI were used to segment the RA in CMR images and segmentations compared with real lesion volumes. The SI thresholds that best approximated histological volumes were 2.3 SD for LGE post-ablation, 14.5 SD for T2W post-ablation and 3.3 SD for LGE chronically. T2-weighted chronically always underestimated lesion volume. Acute histology showed transmural injury with coagulative necrosis. Chronic histology showed transmural fibrous scar. The mean voltage at the centre of the ablation line was 3.3 mV pre-ablation, 0.6 mV immediately post-ablation, and 0.3 mV chronically.

CONCLUSION:

This study presents the first histopathological validation of CMR and endocardial voltage mapping to define acute and chronic atrial ablation injury, including SI thresholds that best match histological lesion volumes. An understanding of these thresholds may allow a more informed assessment of the underlying atrial substrate immediately after ablation and before repeat catheter ablation for atrial arrhythmias.

KEYWORDS:

Ablation; Atrial fibrillation; Electroanatomical mapping; Histology; Magnetic resonance

PMID:
24419806
PMCID:
PMC4048535
DOI:
10.1093/eurheartj/eht560
[Indexed for MEDLINE]
Free PMC Article
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