Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation.
Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation.
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DOI：
10.1016/j.jacc.2011.04.008
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发表时间：
2011-07-05
影响因子：
24
通讯作者：
Marrouche N
中科院分区：
文献类型：
--
作者：
McGann C;Kholmovski E;Blauer J;Vijayakumar S;Haslam T;Cates J;DiBella E;Burgon N;Wilson B;Alexander A;Prastawa M;Daccarett M;Vergara G;Akoum N;Parker D;MacLeod R;Marrouche N
本研究的目的是评估消融后立即（IPA）晚期钆增强（LGE）磁共振成像（MRI）上观察到的急性消融损伤以及与消融后3个月（3 moPA）永久性疤痕的相关性。房颤导管消融术的成功率差异很大，部分原因是手术时关于消融损伤的位置、程度和持久性的信息有限。尽管消融术后数月LGE MRI上的瘢痕量与手术结局相关，但瘢痕的早期影像学预测因子仍然难以捉摸。37名接受房颤消融术的患者在消融前接受了高分辨率MRI，采用3-T扫描仪进行了3维LGE序列、IPA和3 moPA。将IPA扫描的急性左房壁损伤分为高增强（HE）和无增强（NE），并与瘢痕3 moPA进行比较。所有患者均发现HE和NE区的异质性损伤。LGE MRI左房壁NE暗区表现为类似“无复流”现象。虽然左房壁HE、NE和正常组织IPA的含量相似，（37.7 ± 13%，34.3 ± 14%，28.0 ± 11%; p = NS），IPA损伤与3 moPA瘢痕的登记表明，59.0 ± 19%的瘢痕来自NE组织，30.6 ± 15%来自HE组织，10.4 ± 5%来自鉴定为正常的组织。配对t检验比较在NE、HE和正常组织类型中均具有统计学显著性（p < 0.001）。1年随访时心律失常复发与室壁增强程度3 moPA相关（p = 0.02）。放射性消融导致LGE MRI上的异质性损伤，HE和NE壁损伤。NE病变表现出无复流特征，并揭示了3个月时最终疤痕的更好预测因素。瘢痕与手术结果相关，进一步强调了早期瘢痕预测的重要性。
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). 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. 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. 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). 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.
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影响因子：
37.8
作者：
Rogers, WJ;Kramer, CM;Reichek, N
通讯作者：
Reichek, N
影响因子：
37.8
作者：
Oral, H;Scharf, C;Morady, F
通讯作者：
Morady, F
DOI：
10.1046/j.1540-8167.2004.03503.x
发表时间：
2004-05-01
影响因子：
2.7
作者：
Mansour, M;Ruskin, J;Keane, D
通讯作者：
Keane, D
影响因子：
3.3
作者：
Yokokawa, Miki;Tada, Hiroshi;Taniguchi, Koichi
通讯作者：
Taniguchi, Koichi
影响因子：
5.5
作者：
Badger, Troy J.;Oakes, Robert S.;Marrouche, Nassir F.
通讯作者：
Marrouche, Nassir F.