Reproducibility and accuracy of late gadolinium enhancement cardiac magnetic resonance measurements for the detection of left atrial fibrosis in patients undergoing atrial fibrillation ablation procedures.

AIMS: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may define left atrial (LA) anatomy and structural remodelling, and facilitate atrial fibrillation (AF) ablation. We aimed to assess the intra- and inter-observer reproducibility and agreement of LGE-CMR parameters with direct application to AF ablation techniques. METHODS AND RESULTS: One experienced and one non-experienced observer performed complete LGE-CMR data analysis twice, on different days, in 40 randomly selected LGE-CMR examinations [20 performed before ablation (pre-ablation) and 20 performed 3 months after ablation (post-ablation)]. Four additional observers (two experienced and two non-experienced) performed complete LGE-CMR data analysis in a subgroup of 30 patients (15 pre-ablation and 15 post-ablation). All LGE-CMR were performed in sinus rhythm. Intra- and inter-observer reproducibility of LA volume, LA area, and sphericity index (SI) was high: coefficient of variation <10% and intraclass correlation coefficient >0.71. Geometric congruency of repeated reconstruction of LA shape was high: maximal error <5 mm for intra-observer and <8 mm for inter-observer. The precision of scar location increased with extent of scar, and was high (Dice coefficient >0.75) when the scar area was >5 cm2 for a single observer and >15 cm2 for multiple observers. Non-experienced observers performed equally well to experienced observers. CONCLUSION: Late gadolinium enhancement cardiac magnetic resonance measurements of LA area, volume, and SI were reproducible, and geometric congruency of LA shape was high. Location of scar was precise for scar areas >5 cm2 for single observers and >15 cm2 for multiple observers, regardless of the observers' experience. These results may serve as a reference for future studies on the role for substrate-based AF ablation procedures.

Postprocedural LGE-CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation.

INTRODUCTION: The purpose of this study was to compare the anatomical characteristics of scar formation achieved by visual-guided laser balloon (Laser) and radiofrequency (RF) pulmonary vein isolation (PVI), using late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR). METHODS AND RESULTS: We included 17 patients with paroxysmal or early persistent drug resistant AF who underwent Laser ablation; 2 were excluded due to procedure-related complications. The sample was matched with a historical group of 15 patients who underwent PVI using RF. LGE-CMR sequences were acquired before and 3 months post-PVI. Ablation gaps were defined as pulmonary vein (PV) perimeter sections showing no gadolinium enhancement. The number of ablation gaps was lower in Laser versus RF ablations (median 7 vs. 14, P  =  0.015). Complete anatomical PVI (circumferential scar around PV, without gaps) was more frequently achieved with Laser than with RF (39% vs. 19% of PVs, P  =  0.025). Fewer gaps were present at the superior and anterior left PV and posterior right PV antral regions in the Laser group, compared to RF. Scar extension into the PVs was similar in both groups, although RF produced more extensive ablation scar toward the LA body. AF recurrences at 1 year were similar in both groups (Laser 36% vs. RF 27%, P  =  1.00). CONCLUSIONS: Compared to RF, Laser ablation achieved more complete anatomical PVI, with less LA scar extension. However, AF recurrence appears to be similar after Laser compared to RF ablation. Further studies are needed to assess whether the anatomical advantages of Laser ablation translate into clinical benefit in patients with AF.

A narrative review of inherited arrhythmogenic syndromes in young population: role of genetic diagnosis in exercise recommendations.

Sudden cardiac death is a rare but socially devastating event, especially if occurs in young people. Usually, this unexpected lethal event occurs during or just after exercise. One of the leading causes of sudden cardiac death is inherited arrhythmogenic syndromes, a group of genetic entities characterised by incomplete penetrance and variable expressivity. Exercise can be the trigger for malignant arrhythmias and even syncope in population with a genetic predisposition, being sudden cardiac death as the first symptom. Due to genetic origin, family members must be clinically assessed and genetically analysed after diagnosis or suspected diagnosis of a cardiac channelopathy. Early identification and adoption of personalised preventive measures is crucial to reduce risk of arrhythmias and avoid new lethal episodes. Despite exercise being recommended by the global population due to its beneficial effects on health, particular recommendations for these patients should be adopted considering the sport practised, level of demand, age, gender, arrhythmogenic syndrome diagnosed but also genetic diagnosis. Our review focuses on the role of genetic background in sudden cardiac death during exercise in child and young population.

Delayed Gadolinium Enhancement Magnetic Resonance Imaging Detected Anatomic Gap Length in Wide Circumferential Pulmonary Vein Ablation Lesions Is Associated With Recurrence of Atrial Fibrillation.

BACKGROUND: There is limited knowledge about the impact of anatomic gaps as assessed by delayed gadolinium enhancement cardiac magnetic resonance on atrial fibrillation (AF) recurrence after first pulmonary vein (PV) isolation. METHODS: Consecutive patients underwent delayed gadolinium enhancement cardiac magnetic resonance 3 months after radiofrequency circumferential PV isolation. Delayed gadolinium enhancement cardiac magnetic resonance images were assessed from 360 PV resulting in 2880 segments in the 2×8-segment model from 94 patients (52±11 years, 62% paroxysmal AF). Left atria were segmented using dedicated software. Anatomic gap was defined as discontinuation of the ablation line by ≥3 mm. Relative gap length was calculated as absolute gap length divided by the total length of the ablation line. AF recurrence was assessed after a mean follow-up duration of 15±10 months Results: Mean number of anatomic gaps was 5.4 per patient. Recurrence within the first year of ablation was observed in 21 patients with paroxysmal AF (36%) and 19 patients with persistent AF (53%). In the univariate analysis, CHA2DS2-VASc score, AF type, and relative gap length were predictive of recurrence. In the multivariate analysis, only relative gap length was significantly associated with recurrence (hazard ratio, 1.16 [1.02-1.31] per each 10% of gap). CONCLUSIONS: The total relative gap length but not the number of anatomic gaps in the PV ablation line as assessed by delayed gadolinium enhancement cardiac magnetic resonance was associated with AF recurrence 1 year after first PV isolation. An increase of 10% relative gap length increased the likelihood of AF recurrence by 16%.