Optimal timing of contrast-enhanced three-dimensional magnetic resonance left atrial angiography before pulmonary vein ablation

Figures

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  Figure 1. A. Maximum-intensity projection of three-dimensional (3D) contrast-enhanced cardiovascular magnetic resonance (CMR) angiography of the left atrium and pulmonary veins; accurate timing led to the highest relative signal enhancement in left atrium/pulmonary veins; B. Segmented volume rendering reconstruction of the left atrium and pulmonary veins; subsequently generated 3D CMR mesh model can be easily integrated into electroanatomical mapping systems for guidance of catheter ablation procedures; C. Image fusion of electroanatomical map (EnSite Precision, St. Jude Medical, St. Paul, MN, US) and CMR mesh model of left atrium and pulmonary veins during electrophysiological ablation procedure.

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  Figure 2. Measurements of relative signal enhancement (mean ± standard deviation) confirmed the highest values in left atrium (5.1 ± 1.5; p < 0.001) in comparison to the pulmonary artery (2.1 ± 1.1), ascending (4.3 ± 1.2) and descending aorta (4.0 ± 1.3), respectively.

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  Figure 3. Histogram plot of contrast agent travel time in all patients demonstrated a wide variability (range 12–42 s; mean 18 ± 4 s); the blue line indicates fitted normal distribution.

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  Figure 4. Real-time cardiovascular magnetic resonance (CMR) bolus tracking during contrast agent passage: representative extracted frames of contrast agent bolus passage are shown demonstrating its arrival in superior vena cava (SVC), right atrium (RA), right ventricle (RV)/pulmonary artery (PA), lung and left atrium (LA); subsequently, the three-dimensional angiographic imaging sequence was started; A. Sinus rhythm (heart rate 78/min), LV-EF 64%, RV-EF 61%, LA 18 cm2, RA 17 cm2, MI grade 1; B. Atrial fibrillation (heart rate approx. 100/min), LV-EF 23%, RV-EF 24%, LA 29 cm2, RA 27 cm2, MI grade 1; LV — left ventricular; EF — ejection fraction.