Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Figures

• 

  FIGURE 1. Flow chart of the study design and outcome. PVI, pulmonary vein isolation; LGE-CMR, late-gadolinium enhancement cardiac magnetic resonance; Mar, March; Sep, September; PV, pulmonary vein.

• 

  FIGURE 2. Process for ablation points projected onto LGE-CMR left atrial shell. (A) Acquire axial view of left atrium. (B) Manually drawn left atrial wall contour. (C) Posterior view of 3D color-coded LGE-CMR shell. (D) Anterior view of 3D color-coded LGE-CMR shell (E) 3D electroanatomic map of left atrium. (F) The merge of LGE-CMR shell and electroanatomic map. Ablation points were projected onto the surface of 3D LGE-CMR shell of left atrium. IIR, image intensity ratio.

• 

  FIGURE 3. Segmentation of the pulmonary vein. RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein; LSPV, left superior pulmonary vein; LIPV, left inferior pulmonary vein; R-R, right roof; R-AS, right anterior superior; R-AC, right anterior carina; R-AI, right anterior inferior; R-B, right bottom; R-PI, right posterior inferior; R-PC, right posterior carina; R-PS, right posterior superior; L-R, left roof; L-AS, left anterior superior; L-AC, left anterior carina; L-AI, left anterior inferior; L-B, left bottom; L-PI, left posterior inferior; L-PC, left posterior carina; L-PS, left posterior superior; PV, pulmonary vein.

• 

  FIGURE 4. Image intensity ratio and ablation parameters of each PV segment under the ablation line. (A) The distribution of LSI, FTI, duration, power, contact force, and temperature at each segment of PV. (B) Myocardial wall image intensity ratio of each PV segment under ablation line. LSI, lesion size index; FTI, force–time integral; R-R, right roof; R-AS, right anterior superior; R-AC, right anterior carina; R-AI, right anterior inferior; R-B, right bottom; R-PI, right posterior inferior; R-PC, right posterior carina; R-PS, right posterior superior; L-R, left roof; L-AS, left anterior superior; L-AC, left anterior carina; L-AI, left anterior inferior; L-B, left bottom; L-PI, left posterior inferior; L-PC, left posterior carina; L-PS, left posterior superior; RPV, right pulmonary vein; LPV, left pulmonary vein.

• 

  FIGURE 5. Comparison of image intensity ratios between different locations of left atrium under different level ablation parameter categories. Comparison of the image intensity ratio between non-posterior of right PV, posterior of right PV, non-posterior of left PV and posterior of left PV with three levels of (A) LSI, (B) FTI, (C) power, (D) duration, (E) contact force, (F) temperature applications. LSI, lesion size index; FTI, force–time integral; CF, contact force; T, temperature; ns, non-significant. *P < 0.05, **P < 0.01, ***P < 0.001, and ****P < 0.0001.

• 

  FIGURE 6. Prediction of tissue lesion existence after pulmonary vein isolation. (A) Receiver operating characteristic curve analysis for tissue damage existence predictability at non-posterior of right PV. LSI showed the best predictive value with an area under the Receiver operating characteristic (ROC) curve of 0.733 (95% CI 0.676–0.790). Area under the ROC curve for FTI, contact force, temperature, power and duration was 0.661, 0.665, 0.646, 0.582, and 0.514, respectively. The best cutoff value for LSI for tissue lesion was 4.15 (sensitivity 70.8%, specificity 66.8%). (B) Receiver operating characteristic curve analysis for tissue damage existence predictability at non-posterior of left PV. LSI showed the best predictive value with an area under the ROC curve of 0.703 (95% CI 0.647–0.759). Area under the ROC curve for FTI, contact force, temperature, power and duration was 0.668, 0.549, 0.635, 0.600, and 0.651, respectively. The best cutoff value for LSI for tissue lesion was 3.95 (sensitivity 78.6%, specificity 58.6%).

• 

  FIGURE 7. Correlation between image intensity ratio and LSI. (A) Positive correlation between image intensity ratio and LSI at non-posterior of right PV (r = 0.13). (B) There was no correlation between image intensity ratio and LSI at posterior of right PV. (C) Positive correlation between image intensity ratio and LSI at non-posterior of left PV (r = 0.26). (D) There was no correlation between image intensity ratio and LSI at posterior of left PV.