Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation

Jeremy D. Collins; F. Scott Pereles M.D.; David Bello M.D.; Timothy Betts M.D.; Anish Zachariah; Ryan Kaliney; Gina K. Song M.D.; Stephanie M. Shors M.D.; James C. Carr M.D.; John Paul Finn M.D.

doi:10.1117/12.480098

22 May 2003 Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation

Jeremy D. Collins, F. Scott Pereles M.D., David Bello M.D., Timothy Betts M.D., Anish Zachariah, Ryan Kaliney, Gina K. Song M.D., Stephanie M. Shors M.D., James C. Carr M.D., John Paul Finn M.D.

Author Affiliations +

Proceedings Volume 5034, Medical Imaging 2003: Image Perception, Observer Performance, and Technology Assessment; (2003) https://doi.org/10.1117/12.480098
Event: Medical Imaging 2003, 2003, San Diego, California, United States

Abstract

Pulmonary MRA generates high-resolution images of the pulmonary veins (PV) and left atrium (LA), permitting characterization of complex PV anatomy, which is useful in electrophysiologic PV catheter ablation, a proven technique for the treatment of paroxysmal atrial fibrillation (PAF). The purpose of this study was to determine if pre-ablative pulmonary MRA with intra-ablative viewing facilitates ablation by reducing fluoroscopy time. We studied the morphology of the LA and PV at 1.5T (Magnetom Sonata, Siemens Medical Solutions, Erlangen Germany) with breath-held gadolinium-enhanced 3D MRA in 7 patients with PAF undergoing PV ablation. Data was volume rendered (VR) on a stereoscopic workstation. PV ostial diameter and cross-sectional area measurements were obtained on multi-planar reformatted (MPR) images. VR datasets were converted into digital movies and were viewed on a laptop computer adjacent to real-time fluoroscopic images. Fluoroscopy times for patients undergoing pre-ablative MPA mapping were compared with a cohort of 22 consecutive patients diagnosed with PAF who underwent catheter ablation without pre-ablative MRA planning. Mean PV ablation fluoroscopic time with MRA planning versus fluoroscopic imaging alone were 84±20 minutes and 114±20 minutes respectively. Pre-ablative MRA planning resulted in a significant mean fluoroscopy time savings of 26% (p<0.05). In patients with PAF undergoing PV ablation, analysis of MRA datasets depicting PV anatomy confirms that there is great variability in anatomy between veins. Pre-ablative 3D PV mapping by MRA greatly facilitates fluoroscopic identification of individual veins and significantly reduces fluoroscopic radiation time.

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Jeremy D. Collins, F. Scott Pereles M.D., David Bello M.D., Timothy Betts M.D., Anish Zachariah, Ryan Kaliney, Gina K. Song M.D., Stephanie M. Shors M.D., James C. Carr M.D., and John Paul Finn M.D. "Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation", Proc. SPIE 5034, Medical Imaging 2003: Image Perception, Observer Performance, and Technology Assessment, (22 May 2003); https://doi.org/10.1117/12.480098

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