Magnetic Resonance Mapping of Catheter Ablation Lesions After Post-Infarction Ventricular Tachycardia Ablation.

Abstract

OBJECTIVES:

This study sought to describe cardiac magnetic resonance (CMR) characteristics of ablation lesions within post-infarction scar.

BACKGROUND:

Chronic ablation lesions created during radiofrequency ablation of ventricular tachycardia (VT) in the setting of prior myocardial infarction have not been described in humans.

METHODS:

Seventeen patients (15 men, ejection fraction 25 ± 8%, 66 ± 6 years of age) with CMR imaging prior to repeat ablation procedures for VT were studied. Electroanatomic maps from first-time procedures and subsequent CMR images were merged and retrospectively compared with electroanatomic maps from repeat procedures.

RESULTS:

The delay between the index ablation procedure and the CMR study was 30 ± 29 months. Late gadolinium-enhanced CMR revealed a confluent nonenhancing subendocardial dark core within the infarct-related scar tissue in all patients. Intracardiac thrombi were ruled out by transthoracic and intracardiac echocardiography. These core lesions matched the distribution of prior ablation lesions, and corresponded to unexcitable areas at repeat procedures.

CONCLUSIONS:

Ablation lesions can be detected by CMR after VT ablation in post-infarction patients and have a different appearance than scar tissue. These lesions can be observed many months after an initial ablation.

• Authors: Ghaith Sharaf Dabbagh, Michael Ghannam, Konstantinos C Siontis, Anil Attili, Hubert Cochet, Pierre Jais, Mehdi Johoor Eng, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank Bogun
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 14 Issue 3 Pg. 588-598 (03 2021) ISSN: 1876-7591 [Electronic] United States
• PMID: 33248970 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Catheter Ablation
• Humans
• Magnetic Resonance Spectroscopy
• Male
• Myocardial Infarction (complications, diagnostic imaging)
• Predictive Value of Tests
• Retrospective Studies
• Tachycardia, Ventricular (diagnostic imaging, etiology, surgery)