scholarly journals Association between interatrial block, left atrial fibrosis, and mechanical dyssynchrony: Electrocardiography‐magnetic resonance imaging correlation

2020 ◽  
Vol 31 (7) ◽  
pp. 1719-1725 ◽  
Author(s):  
Luisa Ciuffo ◽  
Vanesa Bruña ◽  
Manuel Martínez‐Sellés ◽  
Henrique Doria Vasconcellos ◽  
Susumu Tao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Mechanical Dyssynchrony ◽  
Resonance Imaging ◽  
Atrial Fibrosis ◽  
Interatrial Block ◽  
Left Atrial Fibrosis

Accuracy of left atrial fibrosis detection with cardiac magnetic resonance: correlation of late gadolinium enhancement with endocardial voltage and conduction velocity

EP Europace ◽  
2020 ◽  
Author(s):  
Gala Caixal ◽  
Francisco Alarcón ◽  
Till F Althoff ◽  
Marta Nuñez-Garcia ◽  
Eva Maria Benito ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sinus Rhythm ◽  
Conduction Velocity ◽  
Left Atrial ◽  
Interstitial Fibrosis ◽  
Local Velocity ◽  
Resonance Imaging ◽  
Atrial Fibrosis ◽  
Bipolar Voltage

Abstract Aims Myocardial fibrosis is a hallmark of atrial fibrillation (AF) and its characterization could be used to guide ablation procedures. Late gadolinium enhanced-magnetic resonance imaging (LGE-MRI) detects areas of atrial fibrosis. However, its accuracy remains controversial. We aimed to analyse the accuracy of LGE-MRI to identify left atrial (LA) arrhythmogenic substrate by analysing voltage and conduction velocity at the areas of LGE. Methods and results Late gadolinium enhanced-magnetic resonance imaging was performed before ablation in 16 patients. Atrial wall intensity was normalized to blood pool and classified as healthy, interstitial fibrosis, and dense scar tissue depending of the resulting image intensity ratio. Bipolar voltage and local conduction velocity were measured in LA with high-density electroanatomic maps recorded in sinus rhythm and subsequently projected into the LGE-MRI. A semi-automatic, point-by-point correlation was made between LGE-MRI and electroanatomical mapping. Mean bipolar voltage and local velocity progressively decreased from healthy to interstitial fibrosis to scar. There was a significant negative correlation between LGE with voltage (r = −0.39, P < 0.001) and conduction velocity (r = −0.25, P < 0.001). In patients showing dilated atria (LA diameter ≥45 mm) the conduction velocity predictive capacity of LGE-MRI was weaker (r = −0.40 ± 0.09 vs. –0.20 ± 0.13, P = 0.02). Conclusions Areas with higher LGE show lower voltage and slower conduction in sinus rhythm. The enhancement intensity correlates with bipolar voltage and conduction velocity in a point-by-point analysis. The performance of LGE-MRI in assessing local velocity might be reduced in patients with dilated atria (LA diameter ≥45).

scholarly journals Verification of threshold for image intensity ratio analyses of late gadolinium enhancement magnetic resonance imaging of left atrial fibrosis in 1.5T scans

2019 ◽  
Vol 36 (3) ◽  
pp. 513-520 ◽  
Author(s):  
Litten Bertelsen ◽  
Francisco Alarcón ◽  
Laura Andreasen ◽  
Eva Benito ◽  
Morten Salling Olesen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Elderly Patients ◽  
Healthy Volunteers ◽  
Left Atrial ◽  
Resonance Imaging ◽  
Atrial Fibrosis ◽  
Gadolinium Enhancement ◽  
History Of

AbstractThe use of cardiovascular magnetic resonance imaging left atrial late gadolinium enhancement (LA LGE) is increasing for fibrosis evaluation though the use is still limited to specialized centres due to complex image acquisition and lack of consensus on image analyses. Analysis of LA LGE with image intensity ratio (IIR) (pixel intensity of atrial wall normalized by blood pool intensity) provides an objective method to obtain quantitative data on atrial fibrosis. A threshold between healthy myocardium and fibrosis of 1.2 has previously been established in 3T scans. The aim of the study was to reaffirm this threshold in 1.5T scans. LA LGE was performed using a 1.5T magnetic resonance scanner on: 11 lone-AF patients, 11 age-matched healthy volunteers (aged 27–44) and 11 elderly patients without known history of AF but varying degrees of comorbidities. Mean values of IIR for all healthy volunteers +2SD were set as upper limit of normality and was reproduced to 1.21 and the original IIR-threshold of 1.20 was maintained. The degree of fibrosis in lone-AF patients [median 9.0% (IQR 3.9–12.0)] was higher than in healthy volunteers [2.8% (1.3–8.3)] and even higher in elderly non-AF [20.1% (10.2–35.8), p = 0.001]. The previously established IIR-threshold of 1.2 was reaffirmed in 1.5T LA LGE scans. Patients with lone AF presented with increased degrees of atrial fibrosis compared to healthy volunteers in the same age-range. Elderly patients with no history of AF showed significantly higher degrees of fibrosis compared to both groups with younger individuals.

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