title: Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience.
abstract: BACKGROUND
  We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre- and postablation imaging.
  
  
  METHODS
  Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre- or postablation, and if postablation, whether lesions were in an ostial or WACA distribution.
  
  
  RESULTS
  LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000).
  
  
  CONCLUSIONS
  LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution.
authors.affiliation: Barts and The London NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary, University of London, London, UK.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Hunter
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.forename: Redha
authors.initials: R
authors.lastname: Boubertakh
authors.forename: Louisa C
authors.initials: LC
authors.lastname: Malcolme-Lawes
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.forename: Christoph F
authors.initials: CF
authors.lastname: Juli
authors.forename: D Wyn
authors.initials: DW
authors.lastname: Davies
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Peters
authors.forename: Victoria
authors.initials: V
authors.lastname: Baker
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Simon
authors.initials: S
authors.lastname: Sporton
authors.forename: L Ceri
authors.initials: LC
authors.lastname: Davies
authors.forename: Mark
authors.initials: M
authors.lastname: Westwood
authors.forename: Steffen E
authors.initials: SE
authors.lastname: Petersen
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D003287:Contrast Media; D003452:Cryosurgery / Q000009:adverse effects; D005260:Female; D019786:Gadolinium DTPA; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA