Ablation Lesion Assessment with MRI

• Published in: Arrhythmia & electrophysiology review Vol. 11; p. e02
• Main Authors: Mont, Lluís, Roca-Luque, Ivo, Althoff, Till F
• Format: Journal Article Book Review
• Language: English
• Published: England Radcliffe Group Ltd 01-04-2022; Radcliffe Medical Education Ltd; Radcliffe Cardiology; Radcliffe Medical Media
• Subjects: Ablation; Ablation (Surgery); Cardiac arrhythmia; Clinical Electrophysiology and Ablation; Contrast agents; Edema; Fibroblasts; Gadobutrol; Hypotheses; Magnetic fields; Magnetic resonance imaging; Medical research; Medicine, Experimental; Pathology; Scars; Spain; ablation lesion; fibrosis; Late gadolinium enhancement; MRI
• ISSN: 2050-3369; 2050-3377
• DOI: 10.15420/aer.2021.63

Late gadolinium enhancement (LGE) MRI is capable of detecting not only native cardiac fibrosis, but also ablation-induced scarring. Thus, it offers the unique opportunity to assess ablation lesions non-invasively. In the atrium, LGE-MRI has been shown to accurately detect and localise gaps in ablation lines. With a negative predictive value close to 100% it can reliably rule out pulmonary vein reconnection non-invasively and thus may avoid unnecessary invasive repeat procedures where a pulmonary vein isolation only approach is pursued. Even LGE-MRI-guided repeat pulmonary vein isolation has been demonstrated to be feasible as a standalone approach. LGE-MRI-based lesion assessment may also be of value to evaluate the efficacy of ventricular ablation. In this respect, the elimination of LGE-MRI-detected arrhythmogenic substrate may serve as a potential endpoint, but validation in clinical studies is lacking. Despite holding great promise, the widespread use of LGE-MRI is still limited by the absence of standardised protocols for image acquisition and post-processing. In particular, reproducibility across different centres is impeded by inconsistent thresholds and internal references to define fibrosis. Thus, uniform methodological and analytical standards are warranted to foster a broader implementation in clinical practice.