Heart rhythm O2 · 2026
Ablation lesion patterns in atrial fibrillation: A cardiac MRI comparison of different ablation strategies.
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van Pouderoijen Nikki, van der Graaf Marisa, Abeln Bob G S, Kemme Michiel J B, Liebregts Max, Boersma Lucas V A, Allaart Cornelis P, Hopman Luuk H G A, Götte Marco J W
Аннотация
BACKGROUND: Pulmonary vein (PV) isolation can be performed using various ablation strategies, including point-by-point radiofrequency (RF) and single-shot ablation techniques. However, the resulting lesion characteristics of these approaches are not yet fully understood. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) provides a noninvasive means to assess atrial ablation lesions.
OBJECTIVE: This study aimed to characterize ablation modality-specific left atrial LGE-CMR lesion patterns.
METHODS: Ablation lesion patterns of 42 patients were evaluated on LGE-CMR acquired 3 months after PV isolation was performed with point-by-point moderate-power moderate-duration RF, very-high-power short-duration RF, RF balloon, ultralow-temperature cryoablation, or pulsed field ablation (PFA). Left atrial LGE images were visually assessed and also postprocessed using the full-width half-maximum method for lesion quantification, with gap detection defined by a ≥40% threshold to assess lesion completeness.
RESULTS: Point-by-point RF ablation produced the most continuous LGE lesion patterns, whereas single-shot thermal techniques created broader but less continuous ablation lesions. PFA generated the widest and most heterogeneous patterns, with quantitative analysis confirming a high prevalence and large gap lengths in single-shot ablation groups, most prominently in the PFA group (total LGE encirclement: moderate-power moderate-duration 77.2% ± 10.1%; very-high-power short-duration 82.8% ± 12.4%; RF balloon 76.2% ± 11.6%; ultralow-temperature cryoablation 62.0% ± 9.9%; and PFA 60.2% ± 13.7%).
CONCLUSION: LGE-CMR reveals modality-specific lesion patterns, with point-by-point RF showing the most continuous PV encirclement. PFA demonstrated variable lesion visualization, likely influenced by system differences and challenges in detecting nonthermal injury. The relationship between CMR-defined lesions and outcomes remains uncertain, underscoring the need for standardized imaging with emerging energy sources.
OBJECTIVE: This study aimed to characterize ablation modality-specific left atrial LGE-CMR lesion patterns.
METHODS: Ablation lesion patterns of 42 patients were evaluated on LGE-CMR acquired 3 months after PV isolation was performed with point-by-point moderate-power moderate-duration RF, very-high-power short-duration RF, RF balloon, ultralow-temperature cryoablation, or pulsed field ablation (PFA). Left atrial LGE images were visually assessed and also postprocessed using the full-width half-maximum method for lesion quantification, with gap detection defined by a ≥40% threshold to assess lesion completeness.
RESULTS: Point-by-point RF ablation produced the most continuous LGE lesion patterns, whereas single-shot thermal techniques created broader but less continuous ablation lesions. PFA generated the widest and most heterogeneous patterns, with quantitative analysis confirming a high prevalence and large gap lengths in single-shot ablation groups, most prominently in the PFA group (total LGE encirclement: moderate-power moderate-duration 77.2% ± 10.1%; very-high-power short-duration 82.8% ± 12.4%; RF balloon 76.2% ± 11.6%; ultralow-temperature cryoablation 62.0% ± 9.9%; and PFA 60.2% ± 13.7%).
CONCLUSION: LGE-CMR reveals modality-specific lesion patterns, with point-by-point RF showing the most continuous PV encirclement. PFA demonstrated variable lesion visualization, likely influenced by system differences and challenges in detecting nonthermal injury. The relationship between CMR-defined lesions and outcomes remains uncertain, underscoring the need for standardized imaging with emerging energy sources.