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Quantitative Magnetic Resonance Imaging Analysis of the Relationship between Contact Force and Left Atrial Scar Formation after Catheter Ablation of Atrial Fibrillation

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)138-145
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number2
Early online date2013
DOIs
E-pub ahead of print2013
PublishedFeb 2014

King's Authors

Abstract

Background
Catheter contact force (CF) is an important determinant of radiofrequency (RF) lesion quality during pulmonary vein isolation (PVI). Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) allows good visualization of ablation lesions.

Objective
This study describes a new technique to examine the relationship between CF during RF delivery and LGE signal intensity (SI) following PVI.

Methods
Six patients underwent PVI for paroxysmal AF using a CF-sensing catheter and following pre-procedural MRI. During ablation, contact force-time integral (FTI) and position was documented for each RF application. All patients underwent repeat LGE MRI 3 months later. The LGE SIs were projected onto a MRI-derived three-dimensional left atrial (LA) shell and a CF map was generated on the same shell. The entire LA surface was divided into 5mm2 segments. Force and LGE maps were fused and compared for each 5mm2 zone. An effective lesion was defined when MRI-defined scar occupied >90% of a 5mm2 analysis zone.

Results
Acute PVI was achieved in 100%. 268 RF lesions were tagged on the LA shells and given a lesion-specific FTI. Increasing FTI correlated with increased LGE SI, which was greater when the FTI was > 1200gs. Below an FTI of 1200gs an increment in the FTI resulted in only a small increment in scar, whereas above 1200gs an increment in the FTI resulted in a large change of scar.

Conclusion
There is a correlation between FTI and LGE SI in MRI following AF ablation. Real-time FTI maps are feasible and may prevent inadequate lesion formation.

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