Role of Imaging in Improving Outcomes with Ablation
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Arrhythmia (R Kabra, Section Editor)
Role of Imaging in Improving Outcomes with Ablation Leenhapong Navaravong, MD Ravi Ranjan, MD, PhD* Address * Division of Cardiovascular Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT, 84132, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Arrhythmia Keywords MRI I Ablation I Atrial fibrillation I Ventricular tachycardia
Abstract Purpose of Review The goal of this review is to provide information about the role that cardiac magnetic resonance imaging (CMR) can play in guiding catheter ablation right from patient selection to creating better lesions to post-ablation follow-up. Recent Findings CMR can provide very important information of the scar and fibrotic substrate in the cardiac tissue. Cardiac substrate information from CMR plays a critical role in ventricular and atrial arrhythmia management. CMR can demonstrate the extent of acute edema and long-term scar formation from catheter ablation. All this information can lead to optimal targeting and lesion creation. Summary Understanding all the different aspects of CMR can provide clinical electrophysiologist with valuable information. This results in better managing arrhythmia patients.
Introduction We are now increasingly using catheter ablation for complex arrhythmias including atrial fibrillation (AF) and ventricular tachycardia (VT). The use of cardiac imaging in the practice of cardiac electrophysiology (EP) is very common. As we are targeting more complex arrhythmias, the need to know more about the underlying cardiac structure and the substrate supporting these
arrhythmias is critical for both a better understanding of the arrhythmia and areas to target with ablation. With improvement in imaging, this information about the cardiac structure, function, and tissue characterization are becoming increasingly more valuable part of the management right from patient selection to the procedure itself and also post-ablation management. Cardiac
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Curr Treat Options Cardio Med
magnetic resonance imaging (CMR) is well suited to providing not just the cardiac structural information
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but also the substrate information including assessing ablation lesions after an ablation.
Pre-ablation evaluation with cardiac magnetic resonance imaging Currently, cardiac magnetic resonance imaging (CMR) is the known gold standard for evaluation of chamber sizes, volume, and cardiac ejection fraction (EF). Utilizing techniques like delayed enhancement MRI (DE-MRI) can be very helpful in risk stratification and in preparation for the ablation procedure.
Ventricular tachycardia The critical value of CMR in diagnostic workup for VT or sudden cardiac death is demonstrated in the study by White et al. [1]. It shows that incorporation of CMR can help in identifying the underlying myocardial diagnosis: 50% of the patients in this study received a different diagnosis a
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