TY - JOUR
T1 - Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance
T2 - Review of Imaging Strategies and Histological Correlations
AU - Hopman, Luuk H. G. A.
AU - van Pouderoijen, Nikki
AU - Mulder, Mark J.
AU - van der Laan, Anja M.
AU - Bhagirath, Pranav
AU - Nazarian, Saman
AU - Niessen, Hans W. M.
AU - Ferrari, Victor A.
AU - Allaart, Cornelis P.
AU - Götte, Marco J. W.
N1 - Publisher Copyright: © 2023 American College of Cardiology Foundation
PY - 2023/12
Y1 - 2023/12
N2 - Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
AB - Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
KW - ablation lesion
KW - atrial ablation
KW - atrial fibrillation
KW - cardiac magnetic resonance imaging
KW - interventional MRI
KW - lesion histology
UR - http://www.scopus.com/inward/record.url?scp=85173134275&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jacep.2023.08.013
DO - https://doi.org/10.1016/j.jacep.2023.08.013
M3 - Review article
C2 - 37737780
SN - 2405-500X
VL - 9
SP - 2665
EP - 2679
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 12
ER -