Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation

J. D. Collins*, F. S. Pereies, D. Bello, T. Betts, A. Zachariah, R. Kaliney, G. K. Song, S. M. Shors, J. C. Carr, J. P. Finn

*Corresponding author for this work

Research output: Contribution to journalConference articlepeer-review

Abstract

Purpose Pulmonary MRA generates high-resolution images of the pulmonary veins (PV) and left atrium (LA), permitting characterization of complex PV anatomy, which is useful in electrophysiologic PV catheter ablation, a proven technique for the treatment of paroxysmal atrial fibrillation (PAF). The purpose of this study was to determine if pre-ablative pulmonary MRA with infra-ablative viewing facilitates ablation by reducing fluoroscopy time. Materials/Methods We studied the morphology of the LA and PV at 1.5 T (Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany) with breath-held gadolinium-enhanced 3D MRA in 7 patients with PAF undergoing PV ablation. Data was volume rendered (VR) on a stereoscopic workstation. PV ostial diameter and cross-sectional area measurements were obtained on multi-planar reformatted (MPR) images. VR datasets were converted into digital movies and were viewed on a laptop computer adjacent to real-time fluoroscopic images. Fluoroscopy times for patients undergoing pre-ablative MRA mapping were compared with a cohort of 22 consecutive patients diagnosed with PAF who underwent catheter ablation without pre-ablative MRA planning. Results Mean PV ablation fluoroscopic time with MRA planning versus fluoroscopic imaging alone were 84 ± 20 minutes and 114 ± 20 minutes respectively. Pre-ablative MRA planning resulted in a significant mean fluoroscopy time savings of 26% (p<0.05). Conclusion In patients with PAF undergoing PV ablation, analysis of MRA datasets depicting PV anatomy confirms that there is great variability in anatomy between veins. Pre-ablative 3D PV mapping by MRA greatly facilitates fluoroscopic identification of individual veins and significantly reduces fluoroscopic radiation time.

Original languageEnglish (US)
Pages (from-to)267-269
Number of pages3
JournalProceedings of SPIE - The International Society for Optical Engineering
Volume5034
DOIs
StatePublished - Sep 12 2003
EventMedical Imaging 2003: Image Perception, Observer Performance, and Technology Assessment - San Diego, CA, United States
Duration: Feb 18 2003Feb 20 2003

Keywords

  • 3D MRA
  • Paroxysmal Atrial Fibrillation
  • Pulmonary MRA
  • RF ablation

ASJC Scopus subject areas

  • Electronic, Optical and Magnetic Materials
  • Condensed Matter Physics
  • Computer Science Applications
  • Applied Mathematics
  • Electrical and Electronic Engineering

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