The change in the tissue characterization detected by magnetic resonance imaging after radiofrequency ablation of isthmus-dependent atrial flutter.
BACKGROUND
Radiofrequency (RF) ablation produces thermal necrosis and electrophysiological conduction block when lesions are transmural. However, the phenomenon of endocardial edema may prevent the ablative energy from reaching the deeper layers of the myocardium.


METHODS
Sixty-seven patients underwent RF ablation of the cavotricuspid isthmus (CTI) for isthmus-dependent atrial flutter (AFL; 54 males, 61±9 years). Cardiac magnetic resonance (CMR) imaging was performed 1 day before ablation, and the length and morphology of the CTI were determined. In addition, 1 day and 1 month after ablation, the change in the wall thickness, prevalence of a high signal in the delayed enhancement (DE) and T2-weighted images at the CTI were evaluated.


RESULTS
Before ablation, DE regions at the CTI were found in 2 patients with a concave type and 1 with a pouch type. No region with a high T2 signal at the CTI was observed in any of the 67 patients. One day after ablation, high T2 signals were detected at the CTI, and the wall thickness was significantly augmented (p<0.0001). CMR also revealed a DE at the CTI in 46 patients (69%). One month after ablation, the thickened wall with a high T2 signal recovered to baseline, and a DE at the CTI was found in 56 patients (84%).


CONCLUSIONS
CMR is useful for assessing the creation of endocardial edema and scar tissue resulting from CTI ablation. These results may correlate with the anatomical isthmus block after ablation in a large portion of the patients with isthmus-dependent AFL.
Yokokawa
Miki
M
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Tada
Hiroshi
H
Koyama
Keiko
K
Ino
Toshihiko
T
Naito
Shigeto
S
Oshima
Shigeru
S
Taniguchi
Koichi
K
D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014261:Tricuspid Valve / Q000473:pathology* / Q000601:surgery