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

被引：116

作者：

Harrison, James L. ^{[1
,2
]}

Jensen, Henrik K. ^{[3
]}

Peel, Sarah A. ^{[1
]}

Chiribiri, Amedeo ^{[1
,2
]}

Grondal, Anne K. ^{[4
,5
]}

Bloch, Lars O. ^{[3
,5
]}

Pedersen, Steen F. ^{[4
]}

Bentzon, Jacob F. ^{[3
,6
]}

Kolbitsch, Christoph ^{[1
]}

Karim, Rashed ^{[1
]}

Williams, Steven E. ^{[1
,2
]}

Linton, Nick W. ^{[1
,2
]}

Rhode, Kawal S. ^{[1
]}

Gill, Jaswinder ^{[1
,2
]}

Cooklin, Michael ^{[2
]}

Rinaldi, C. A. ^{[1
,2
]}

Wright, Matthew ^{[1
,2
]}

Kim, Won Y. ^{[3
,5
]}

Schaeffter, Tobias ^{[1
]}

Razavi, Reza S. ^{[1
]}

O'Neill, Mark D. ^{[1
,2
]}

机构：

[1] Kings Coll London, St Thomas Hosp, Med Engn Ctr, Div Imaging Sci & Biomed Engn, London SE1 7EH, England

[2] Guys & St Thomas NHS Fdn Trust, Dept Cardiol, London, England

[3] Aarhus Univ Hosp Skejby, Dept Cardiol, Aarhus, Denmark

[4] Aarhus Univ Hosp Skejby, Dept Cardiothorac & Vasc Surg, Aarhus, Denmark

[5] Aarhus Univ Hosp Skejby, MR Ctr, Aarhus, Denmark

[6] Aarhus Univ, Dept Clin Med, Aarhus, Denmark

来源：

EUROPEAN HEART JOURNAL | 2014年 / 35卷 / 22期

基金：

英国工程与自然科学研究理事会; 英国惠康基金;

关键词：

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

D O I：

10.1093/eurheartj/eht560

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1486 / 1495

页数：10