A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation.

AIMS: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. CONCLUSION: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.

Retrospectively gated cardiac cine imaging with temporal and spatial acceleration.

Parallel imaging methods are routinely used to accelerate the image acquisition process in cardiac cine imaging. The addition of a temporal acceleration method, whereby k-space is sampled differently for different time frames, has been shown in prior work to improve image quality as compared to parallel imaging by itself. However, such temporal acceleration strategies prove difficult to combine with retrospectively gated cine imaging. The only currently published method to feature such combination, by Hansen et al. [Magn Reson Med 55 (2006) 85-91] tends to be associated with prohibitively long reconstruction times. The goal of the present work was to develop a retrospectively gated cardiac cine method that features both parallel imaging and temporal acceleration, capable of achieving significant acceleration factors on commonly available hardware and associated with reconstruction times short enough for practical use in a clinical context. Seven cardiac patients and a healthy volunteer were recruited and imaged, with acceleration factors of 3.5 or 4.5, using an eight-channel product cardiac array on a 1.5-T system. The prescribed FOV value proved slightly too small in three patients, and one of the patients had a bigemini condition. Despite these additional challenges, good-quality results were obtained for all slices and all patients, with a reconstruction time of 0.98±0.07 s per frame, or about 20 s for a 20-frame slice, using a single processor on a single PC. As compared to using parallel imaging by itself, the addition of a temporal acceleration strategy provided much resistance to artifacts.