title: Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using MRI.
abstract: BACKGROUND
  Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model.
  
  
  RESULTS
  For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67% of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R(2) of 0.81) with that measured by MRI.
  
  
  CONCLUSIONS
  Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.
authors.affiliation: Departments of Medicine/Cardiology, University of Utah, Salt Lake City, 84132, USA. ravi.ranjan@hsc.utah.edu
authors.forename: Ravi
authors.initials: R
authors.lastname: Ranjan
authors.forename: Ritsushi
authors.initials: R
authors.lastname: Kato
authors.forename: Menekhem M
authors.initials: MM
authors.lastname: Zviman
authors.forename: Timm M
authors.initials: TM
authors.lastname: Dickfeld
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Tomaselli
authors.forename: Henry R
authors.initials: HR
authors.lastname: Halperin
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020127:Recovery of Function; D016896:Treatment Outcome