Abstract
Isolation of the pulmonary veins has emerged as a new therapy for atrial fibrillation. Pre-procedural magnetic resonance (MR) imaging enhances safety and efficacy; moreover, it reduces radiation exposure of the patients and interventional team. The purpose of this study was to optimize the MR protocol with respect to image quality and acquisition time. In 31 patients (23–73 years), the anatomy of the pulmonary veins, left atrium and oesophagus was assessed on a 1.5-Tesla scanner with four different sequences: (1) ungated two-dimensional true fast imaging with steady precession (2D-TrueFISP), (2) ECG/breath-gated 3D-TrueFISP, (3) ungated breath-held contrast-enhanced three-dimensional turbo fast low-angle shot (CE-3D-tFLASH), and (4) ECG/breath-gated CE-3D-TrueFISP. Image quality was scored from 1 (structure not visible) to 5 (excellent visibility), and the acquisition time was monitored. The pulmonary veins and left atrium were best visualized with CE-3D-tFLASH (scores 4.50 ± 0.52 and 4.59 ± 0.43) and ECG/breath-gated CE-3D-TrueFISP (4.47 ± 0.49 and 4.63 ± 0.39). Conspicuity of the oesophagus was optimal with CE-3D-TrueFISP and 2D-TrueFISP (4.59 ± 0.35 and 4.19 ± 0.46) but poor with CE-3D-tFLASH (1.03 ± 0.13) (p < 0.05). Acquisition times were shorter for 2D-TrueFISP (44 ± 1 s) and CE-3D-tFLASH (345 ± 113 s) compared with ECG/breath-gated 3D-TrueFISP (634 ± 197 s) and ECG/breath-gated CE-3D-TrueFISP (636 ± 230 s) (p < 0.05). In conclusion, an MR imaging protocol comprising CE-3D-tFLASH and 2D-TrueFISP allows assessment of the pulmonary veins, left atrium and oesophagus in less than 7 min and can be recommended for pre-procedural imaging before electric isolation of pulmonary veins.
Similar content being viewed by others
References
Jaïs P, Haïssaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, Clémenty J (1997) A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 95:572–576
Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666
Mansour M, Holmvang G, Sosnovik D, Migrino R, Abbara S, Ruskin J, Keane D (2004) Assessment of pulmonary vein anatomic variability by magnetic resonance imaging: implications for catheter ablation techniques for atrial fibrillation. J Cardiovasc Electrophysiol 15:387–393
Preis O, Digumarthy SR, Wright CD, Shepard JA (2007) Atrioesophageal fistula after catheter pulmonary venous ablation for atrial fibrillation: imaging features. J Thorac Imaging 22:283–285
Heist EK, Chevalier J, Holmvang G, Singh JP, Ellinor PT, Milan DJ, D’Avila AD, Mela T, Ruskin JN, Mansour M (2006) Factors affecting error in integration of electroanatomic mapping with CT and MR imaging during catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 17:21–27
Cronin P, Sneider MB, Kazerooni EA, Kelly AM, Scharf C, Oral H, Morady F (2004) MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: a how-to guide. AJR Am J Roentgenol 183:767–778
Dong J, Dickfeld T, Dalal D, Cheema A, Vasamreddy CR, Henrikson CA, Marine JE, Halperin HR, Berger RD, Lima JA, Bluemke DA, Calkins H (2006) Initial experience in the use of integrated electroanatomic mapping with three-dimensional MR/CT images to guide catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17:459–466
So NM, Lam WW, Li D, Chan AK, Sanderson JE, Metreweli C (2005) Magnetic resonance coronary angiography with 3D TrueFISP: breath-hold versus respiratory gated imaging. Br J Radiol 78:116–121
Weber OM, Martin AJ, Higgins CB (2003) Whole-heart steady-state free precession coronary artery magnetic resonance angiography. Magn Res Med 50:1223–1228
Prince MR, Meaney JF (2006) Expanding role of MR angiography in clinical practice. Eur Radiol 16(Suppl 2):B3–B8
Jongbloed MR, Dirksen MS, Bax JJ, Boersma E, Geleijns K, Lamb HJ, van der Wall EE, de Roos A, Schalij MJ (2005) Multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation-initial experience. Radiology 234:702–709
Kistler PM, Rajappan K, Jahngir M, Earley MJ, Harris S, Abrams D, Gupta D, Liew R, Ellis S, Sporton SC, Schilling RJ (2006) The impact of CT image integration into an electroanatomic mapping system on clinical outcomes of catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17:1093–1101
Hausleiter J, Meyer T, Hadamitzky M, Huber E, Zankl M, Martinoff S, Kastrati A, Schömig A (2006) Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation 113:1305–1310
Mansour M, Refaat M, Heist EK, Mela T, Cury R, Holmvang G, Ruskin JN (2006) Three-dimensional anatomy of the left atrium by magnetic resonance angiography: implications for catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 17:719–723
Malchano ZJ, Neuzil P, Cury RC, Holmvang G, Weichet J, Schmidt EJ, Ruskin JN, Reddy VY (2006) Integration of cardiac CT/MR imaging with three-dimensional electroanatomical mapping to guide catheter manipulation in the left atrium: implications for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 17:1221–1229
Syed MA, Peters DC, Rashid H, Arai AE (2005) Pulmonary vein imaging: comparison of 3D magnetic resonance angiography with 2D cine MRI for characterizing anatomy and size. J Cardiovasc Magn Reson 7:355–360
Lickfett L, Dickfeld T, Kato R, Tandri H, Vasamreddy CR, Berger R, Bluemke D, Lüderitz B, Halperin H, Calkins H (2005) Changes o pulmonary vein orifice size and location throughout the cardiac cycle: dynamic analysis using magnetic resonance cine imaging. J Cardiovasc Electrophysiol 16:582–588
Thomsen HS (2006) Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol 16:2619–21
Cury RC, Abbara S, Schmidt S, Malchano ZJ, Neuzil P, Weichet J, Ferencik M, Hoffmann U, Ruskin JN, Brady TJ, Reddy VY (2005) Relationship of the oesophagus and aorta to the left atrium and pulmonary veins: implications for catheter ablation of atrial fibrillation. Heart Rhythm 2:1317–1323
Tsao HM, Wu MH, Higa S, Lee KT, Tai CT, Hsu NW, Chang CY, Chen SA (2005) Anatomic relationship of the oesophagus and left atrium: implication for catheter ablation of atrial fibrillation. Chest 128:2581–2587
Good E, Oral H, Lemola K, Han J, Tamirisa K, Igic P, Elmouchi D, Tschopp D, Reich S, Chugh A, Bogun F, Pelosi F, Morady F (2005) Movement of the oesophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol 46:2107–2110
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Allgayer, C., Zellweger, M.J., Sticherling, C. et al. Optimization of imaging before pulmonary vein isolation by radiofrequency ablation: breath-held ungated versus ECG/breath-gated MRA. Eur Radiol 18, 2879–2884 (2008). https://doi.org/10.1007/s00330-008-1070-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-008-1070-2