Key result
3D respiratory and ECG gated, gadolinium enhanced MRA of the pulmonary veins and left atrium achieved good or excellent image quality in 90.1% of patients, independent of heart rate or rhythm.
Why the study?
Does 3D respiratory and ECG gated gadolinium enhanced MRA on a 3T scanner provide high image quality independent of heart rate and rhythm in patients undergoing pre-AF ablation imaging?
Cross-Sectional (n=101)
No
Does 3D respiratory and ECG gated gadolinium enhanced MRA on a 3T scanner provide high image quality independent of heart rate and rhythm in patients undergoing pre-AF ablation imaging?
Odds Ratio: 1.25 (95% CI 0.2–7.69)
p-value: p=0.81
Free-breathing, 3D respiratory and ECG-gated gadolinium-enhanced MRA at 3T is feasible for pre-AF ablation imaging, providing high-quality images independent of heart rate and rhythm.
Supports gated 3D MRA feasibility for pre-AF ablation across rhythms; leaves open prospective validation versus standard protocols.
We aimed to assess the feasibility of 3 dimensional (3D) respiratory and ECG gated, gadolinium enhanced magnetic resonance angiography (MRA) on a 3 Tesla (3 T) scanner for imaging pulmonary veins (PV) and left atrium (LA). The impact of heart rate (HR) and rhythm irregularity associated with atrial fibrillation (AF) on image and segmentation qualities were also assessed. 101 consecutive patients underwent respiratory and ECG gated (ventricular end systolic window) MRA for pre AF ablation imaging. Image quality (assessed by PV delineation) was scored as 1 = not visualized, 2 = poor, 3 = good and 4 = excellent. Segmentation quality was scored on a similar 4 point scale. Signal to noise ratios (SNRs) were calculated for the LA, LA appendage (LAA), and PV. Contrast to noise ratios (CNRs) were calculated between myocardium and LA, LAA and PV, respectively. Associations between HR/rhythm and quality metrics were assessed. 35 of 101 (34.7%) patients were in AF at time of MRA. 100 (99%) patients had diagnostic studies, and 91 (90.1%) were of good or excellent quality. Overall, mean ± standard deviation (SD) image quality score was 3.40 ± 0.69. Inter observer agreement for image quality scores was substantial, (kappa = 0.68; 95% confidence interval (CI): 0.46, 0.90). Neither HR adjusting for rhythm [odds ratio (OR) = 1.03, 95% CI = 0.98,1.09; p = 0.22] nor rhythm adjusting for HR [OR = 1.25, 95% CI = 0.20, 7.69; p = 0.81] demonstrated association with image quality. Similarly, SNRs and CNRs were largely independent of HR after adjusting for rhythm. Segmentation quality scores were good or excellent for 77.3% of patients: mean ± SD score = 2.91 ± 0.63, and scores did not significantly differ by baseline rhythm (p = 0.78). 3D respiratory and ECG gated, gadolinium enhanced MRA of the PVs and LA on a 3 T system is feasible during ventricular end systole, achieving high image quality and high quality image segmentation when imported into electroanatomic mapping systems. Quality is independent of HR and heart rhythm for this free breathing, radiation free, alternative strategy to current MRA or CT based approaches, for pre AF ablation imaging of PVs and LA.
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Groarke et al. (2014) conducted a cross-sectional in Atrial fibrillation (n=101). 3D respiratory and ECG gated, gadolinium enhanced MRA was evaluated on Association of heart rhythm with good or excellent image quality (adjusting for heart rate) (OR 1.25, 95% CI 0.20, 7.69, p=0.81). 3D respiratory and ECG gated, gadolinium enhanced MRA of the pulmonary veins and left atrium achieved good or excellent image quality in 90.1% of patients, independent of heart rate or rhythm.
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