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Cardiac MRI allows evaluation of different ablation techniques in patients undergoing pulmonary vein ablation

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Journal of Cardiovascular Magnetic Resonance201012(Suppl 1):P55

https://doi.org/10.1186/1532-429X-12-S1-P55

Published: 21 January 2010

Keywords

  • Atrial Fibrillation
  • Pulmonary Vein
  • Cardiac Magnetic Resonance
  • Cardiac Magnetic Resonance Imaging
  • Paroxysmal Atrial Fibrillation

Background

Pulmonary vein antrum isolation (PVAI) is regarded as an alternative therapy in atrial fibrillation (AF) patients. Dreaded complications of PVAI are pulmonary vein stenoses, which might be influenced by the applied ablation technique and material. Cardiac magnetic resonance imaging (CMR) has been introduced as a new tool for evaluation of ablation results.

Methods

20 patients (14 male, 63,1 ± 9,1 y) with paroxysmal AF were included. 10 patients underwent PVAI with radiofrequency ablation (RFA), whereas the others received ablation with Cryoballoon (CBA). All patients were scheduled for CMR (Espree 1.5 T, Siemens, Germany) before, acute, and 24 hours after PVI. For pulmonary veins, cross sectional diameter, angiography of pulmonary veins and flow measurements of the right inferior pulmonary vein (RIPV) were performed.

Results

In RFA patients, RIPV diameters signifcantly decreased during, and re-increased 24 h after PVI. RIPV blood flow significantly increased during, and slightly increased after intervention (Table 1). Also, pulmonary congestion and pleural effusion, which occurred acutely during PVI were recurrent after 24 h. Patients undergoing PVAI with Cryoballoon has no significant changes in parametes or signs of deterioration.

Table 1

 

Before PVAI

Acute after PVAI

24 hours after PVAI

RFA

   

RIPV Diameter (mm)

11.7 ± 1.83

9.1 ± 2.42*

11.2 ± 2.66^

Flow (cm/s

34.28 ± 13.97

42.46 ± 13.99°

46.74 ± 13.87^

CBA

   

RIPV Diameter (mm)

11.3 ± 2.94

12.0 ± 3.09°

12.6 ± 3.78#

Flow (cm/s)

42.89 ± 11.91

35.98 ± 9.56°

34.7 ± 12.07#

*before vs. acute p < 0.05 ^acute vs. 24 h after p < 0.05

° before vs. acute p = n.s.# acute vs. 24 h after p = n.s.

Summary

Patients undergoing RFA suffered from reversible pulmonary vein stenosis by edema of the tissue, pulmonary congestion and pleural effusion, wheras patients undergoing CBA seemed to have no relevant deterioration early after PVAI. The choice of ablation technique and material seemed to determine the occurrence of complications, which could be reliably detected and evaluated by CMR. Thus, CMR might be used for evaluation of different ablation techniques in patients undergoing PVAI.

Authors’ Affiliations

(1)
Klinikum Coburg, Coburg, Germany

Copyright

© Mahnkopf et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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