Key result
LGE-MRI shows detectable ablation-induced fibrosis decreases ~32% from three to twenty-eight months post-ablation.
Why the study?
Neither the long-term development of ablation lesions nor the capability of LGE-MRI to detect ablation-induced fibrosis at late stages of scar formation had been defined.
Does LGE-MRI at 3 months post-ablation more accurately detect ablation-induced fibrosis compared to LGE-MRI at >12 months post-ablation in patients who underwent pulmonary vein isolation?
Observational (n=22)
Does LGE-MRI at 3 months post-ablation more accurately detect ablation-induced fibrosis compared to LGE-MRI at >12 months post-ablation in patients who underwent pulmonary vein isolation?
Absolute Event Rate: 91.7% vs 62.8%
p-value: p=<0.0001
LGE-MRI accurately detects ablation-induced fibrosis at 3 months post-ablation, but its detectability decreases significantly over time, suggesting scans should be performed at 3 months rather than later for redo-procedure guidance.
LGE-MRI fibrosis detection declines after 3 months post-PVI; leaves open optimal scan timing for redo guidance in observational data.
AIMS: Neither the long-term development of ablation lesions nor the capability of late gadolinium enhancement (LGE)-MRI to detect ablation-induced fibrosis at late stages of scar formation have been defined. We sought to assess the development of atrial ablation lesions over time using LGE-MRI and invasive electroanatomical mapping (EAM). METHODS AND RESULTS: Ablation lesions and total atrial fibrosis were assessed in serial LGE-MRI scans 3 months and >12 months post pulmonary vein (PV) isolation. High-density EAM performed in subsequent repeat ablation procedures served as a reference. Serial LGE-MRI of 22 patients were analyzed retrospectively. The PV encircling ablation lines displayed an average LGE, indicative of ablation-induced fibrosis, of 91.7% ± 7.0% of the circumference at 3 months, but only 62.8% ± 25.0% at a median of 28 months post ablation (p < 0.0001). EAM performed in 18 patients undergoing a subsequent repeat procedure revealed that the consistent decrease in LGE over time was owed to a reduced detectability of ablation-induced fibrosis by LGE-MRI at time-points > 12 months post ablation. Accordingly, the agreement with EAM regarding detection of ablation-induced fibrosis and functional gaps was good for the LGE-MRI at 3 months (κ .74; p < .0001), but only weak for the LGE-MRI at 28 months post-ablation (κ .29; p < .0001). CONCLUSION: While non-invasive lesion assessment with LGE-MRI 3 months post ablation provides accurate guidance for future redo-procedures, detectability of atrial ablation lesions appears to decrease over time. Thus, it should be considered to perform LGE-MRI 3 months post-ablation rather than at later time-points > 12 months post ablation, like for example, prior to a planned redo-ablation procedure.
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Althoff et al. (2021) conducted an observational in Post pulmonary vein isolation (n=22). LGE-MRI at 3 months post ablation vs. LGE-MRI at >12 months post ablation was evaluated on Average LGE of the PV encircling ablation lines circumference (p=<0.0001). LGE-MRI assessment of ablation-induced fibrosis showed significantly higher detection at 3 months (91.7% of circumference) compared to a median of 28 months post-ablation (62.8%, p<0.0001).
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