title: MRI Evaluation of Radiofrequency, Cryothermal, and Laser Left Atrial Lesion Formation in Patients with Atrial Fibrillation.
abstract: BACKGROUND
  Catheter ablation utilizing radiofrequency (RF), Cryothermal (Cryo), or Laser energy is effective for treatment of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been used to estimate the burden of left atrial (LA) fibrosis, but no data exist regarding structural changes following each modality. We sought to compare the baseline to postprocedure change in LA scar burden following RF, Cryo, or Laser ablation for treatment of AF.
  
  
  METHODS
  Seventeen patients with AF underwent initial pulmonary vein (PV) isolation (PVI) using RF (n = 7), Cryo (n = 5), and Laser (n = 5). LGE-MRI was performed prior to and at 24 hours and 3 months after PVI.
  
  
  RESULTS
  In a linear mixed-effects model, accounting for intrapatient clustering of data and interpatient differences in baseline scar, LGE extent was significantly increased at 24 hours postablation (+14.6 ± 1.9% of LA myocardium, P < 0.001), and remained stable from 24 hours to 3 months (+0.12 ± 1.9%, P = 0.951). There was no statistically significant difference between the postablation scar extent among ablation modalities when compared to RF (Cryo +4.5 ± 3.0%, P = 0.123; Laser -3.2 ± 3.0%, P = 0.291). The PV antral LGE intensity was increased by 25.1 ± 3.8% (P<0.001) 24 hours after ablation and additionally increased by 8.1 ± 3.8 at 3 months (P = 0.033).
  
  
  CONCLUSIONS
  Radiofrequency, Cryo, and laser ablation result in increased LGE extent and intensity at 24 hours and 3 months postablation. No statistically significant difference was noted in the extent of fibrosis induced by any modality.
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Irfan M
authors.initials: IM
authors.lastname: Khurram
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: John N
authors.initials: JN
authors.lastname: Catanzaro
authors.affiliation: Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: Department of Biostatistics, The Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Vadim
authors.initials: V
authors.lastname: Zipunnikov
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jane
authors.initials: J
authors.lastname: Dewire
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Marine
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Spragg
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ashikaga
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Henry
authors.initials: H
authors.lastname: Halperin
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Department of Medicine/Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, Maryland.
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects*; D002921:Cicatrix / Q000175:diagnosis* / Q000209:etiology*; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis / Q000209:etiology; D005682:Gadolinium; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins
chemical_list: D005682:Gadolinium
keywords: Cryothermal; Laser; ablation; atrial fibrillation; imaging; radiofrequency