Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study
Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study
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DOI：
10.1093/eurheartj/eht560
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发表时间：
2014-06-01
影响因子：
39.3
通讯作者：
O'Neill, Mark D.
中科院分区：
文献类型：
--
作者：
Harrison, James L.;Jensen, Henrik K.;O'Neill, Mark D.
目的为急慢性心房消融损伤的心脏磁共振(CMR)和心内膜电压标测提供全面的组织病理学验证。方法与结果对16只猪进行消融前T2加权(T2W)和晚期Gd增强(LGE)CMR和高密度电压标测右心房(RA)，并在腔内线性射频消融后重复。术后处死8头猪进行病理检查。另8头猪在慢性CMR前恢复8周，重复RA电压标测和病理检查。采用高于参考信号强度0~15SD的信号强度(SI)阈值分割CMR图像中的RA，并与实际病变体积进行比较，最接近组织学体积的SI阈值分别为LGE消融后2.3SD、T2W消融后14.5SD和LGE 3.3SD。T2加权成像总是低估病变体积。急性组织学检查显示穿壁损伤伴凝固性坏死。慢性组织学表现为穿壁纤维性瘢痕。消融线中心的平均电压在消融前为3.3 mV，消融后立即为0.6 mV，消融后为0.3 mV。结论本研究首次在组织病理学上验证了CMR和心内膜电压标测对急性和慢性心房消融损伤的诊断价值，包括与组织学病变体积最匹配的SI阈值。对这些阈值的了解可能有助于在房性心律失常消融后和重复导管消融之前立即对潜在的心房基质进行更全面的评估。
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.