Ghaith Sharaf Dabbagh1, Michael Ghannam1, Konstantinos C Siontis2, Anil Attili3, Hubert Cochet4, Pierre Jais4, Mehdi Johoor Eng4, Rakesh Latchamsetty1, Krit Jongnarangsin1, Fred Morady1, Frank Bogun5. 1. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. 3. Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA. 4. Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France; INRIA, Sophia Antipolis, France. 5. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: fbogun@umich.edu.
Abstract
OBJECTIVES: This study sought to describe cardiac magnetic resonance (CMR) characteristics of ablation lesions within post-infarction scar. BACKGROUND: Chronic ablation lesions created during radiofrequency ablation of ventricular tachycardia (VT) in the setting of prior myocardial infarction have not been described in humans. METHODS: Seventeen patients (15 men, ejection fraction 25 ± 8%, 66 ± 6 years of age) with CMR imaging prior to repeat ablation procedures for VT were studied. Electroanatomic maps from first-time procedures and subsequent CMR images were merged and retrospectively compared with electroanatomic maps from repeat procedures. RESULTS: The delay between the index ablation procedure and the CMR study was 30 ± 29 months. Late gadolinium-enhanced CMR revealed a confluent nonenhancing subendocardial dark core within the infarct-related scar tissue in all patients. Intracardiac thrombi were ruled out by transthoracic and intracardiac echocardiography. These core lesions matched the distribution of prior ablation lesions, and corresponded to unexcitable areas at repeat procedures. CONCLUSIONS: Ablation lesions can be detected by CMR after VT ablation in post-infarction patients and have a different appearance than scar tissue. These lesions can be observed many months after an initial ablation.
OBJECTIVES: This study sought to describe cardiac magnetic resonance (CMR) characteristics of ablation lesions within post-infarction scar. BACKGROUND: Chronic ablation lesions created during radiofrequency ablation of ventricular tachycardia (VT) in the setting of prior myocardial infarction have not been described in humans. METHODS: Seventeen patients (15 men, ejection fraction 25 ± 8%, 66 ± 6 years of age) with CMR imaging prior to repeat ablation procedures for VT were studied. Electroanatomic maps from first-time procedures and subsequent CMR images were merged and retrospectively compared with electroanatomic maps from repeat procedures. RESULTS: The delay between the index ablation procedure and the CMR study was 30 ± 29 months. Late gadolinium-enhanced CMR revealed a confluent nonenhancing subendocardial dark core within the infarct-related scar tissue in all patients. Intracardiac thrombi were ruled out by transthoracic and intracardiac echocardiography. These core lesions matched the distribution of prior ablation lesions, and corresponded to unexcitable areas at repeat procedures. CONCLUSIONS: Ablation lesions can be detected by CMR after VT ablation in post-infarctionpatients and have a different appearance than scar tissue. These lesions can be observed many months after an initial ablation.
Authors: Lobke L Pype; Robert J Holtackers; Bernard P Paelinck; Thalia Bekelaar; Hein Heidbuchel; Caroline M Van De Heyning Journal: BJR Case Rep Date: 2022-02-02