| McGann et al., 200899 McGann CJ, Kholmovski EG, Oakes RS, Blauer JJ, Daccarett M, Segerson N, et al. New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J Am Coll Cardiol. 2008;52(15):1263-71.
|
RFCA |
PVI in addition to LA posterior wall and septal debulking. |
Externally irrigated ablation
catheter |
3 months after ablation |
Patients with scar ratios > 13% are 18.5 times more likely to have a favorable outcome and freedom from AF at 3 months |
| Peters et al., 20091010 Peters DC, Wylie JV, Hauser TH, Nezafat R, Han Y, Woo JJ, et al. Recurrence of atrial fibrillation correlates with the extent of post-procedural late gadolinium enhancement: a pilot study. JACC Cardiovasc Imaging. 2009;2(3):308-16.
|
RFCA |
PVI without routine addition of empiric ablation lines in the LA. |
8-mm standard tip: N = 29 (83%); 3.5-mm externally irrigated tip ablation catheter: N = 6 (17%) |
46 ± 28 days after ablation |
AF recurrence during the first year is associated with a lesser degree of PV and LA scarring after ablation |
| Badger et al., 20101111 Badger TJ, Daccarett M, Akoum NW, Adjei-Poku YA, Burgon NS, Haslam TS, et al. Evaluation of left atrial lesions after initial and repeat atrial fibrillation ablation: lessons learned from delayed-enhancement MRI in repeat ablation procedures. Circ Arrhythm Electrophysiol. 2010;3(3):249-59.
|
RFCA |
PVA isolation with posterior wall and septal debulking |
3.5-mm Thermocool irrigated tip ablation catheter |
3 months after ablation |
Patients with successful AF
termination had higher average
total LA wall scar after ablation of
16.4 ± 9.8% (p = 0.004) and percent
PVA scar of 66.2 ± 25.4 (p = 0.01) |
| Akoum et al., 20111212 Akoum N, Daccarett M, McGann C, Segerson N, Vergara G, Kuppahally S, et al. Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J Cardiovasc Electrophysiol. 2011;22(1):16-22.
|
RFCA |
PVI in a circular fashion in the PVA and additional debulking in LA posterior wall and septum |
10-pole circular mapping catheter: N = NR; 3.5 mm Thermocool ablation catheter: N = NR |
3 months after ablation |
Overall post-ablation LA wall
scarring predicts recurrence in
moderate fibrosis stages |
| McGann et al., 20111313 McGann C, Kholmovski E, Blauer J, Vijayakumar S, Haslam T, Cates J, et al. Dark regions of no-reflow on late gadolinium enhancement magnetic resonance imaging result in scar formation after atrial fibrillation ablation. J Am Coll Cardiol. 2011;58(2):177-85.
|
RFCA |
PVI in addition to posterior wall and septal debulking |
3.5-mm Thermocool ablation catheter |
Immediately following ablation and 3 months after ablation |
At 1-year follow-up, patients with moderate scar formation 3 months after ablation had no AF recurrence. In comparison, all recurrences occurred in patients with mild scar formation 3 months after ablation (p = 0.02). |
| Hunter et al., 20131616 Hunter RJ, Jones DA, Boubertakh R, Malcolme-Lawes LC, Kanagaratnam P, Juli CF, et al. Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience. J Cardiovasc Electrophysiol 2013;24(4):396-403.
|
RFCA and cryoballoon ablation |
PVI by WACA
or ostial
ablation with a
cryoballoon |
3.5-mm irrigated ablation catheter: N = NR
For cryoballoon ablation an 11F FlexCath sheath delivered a 23- or 28-mm cryoablation balloon: N = NR |
Pre-ablation and 3 months after ablation |
The proportion of patients free from AF was unaffected by whether ablation lesions could be identified on imaging: 16 of 30 patients (53%) with ablation lesions identified remained free from AF compared to 13 of 20 patients (65%) with no lesions identified (p = 0.560). |
| Akoum et al., 20151414 Akoum N, Wilber D, Hindricks G, Jais P, Cates J, Marchlinski F, et al. MRI Assessment of ablation-induced scarring in atrial fibrillation: analysis from the DECAAF study. J Cardiovasc Electrophysiol. 2015;26(5):473-80.
|
RFCA and cryoballoon ablation |
PVI with CFAE ablation, linear ablation lines of the CTI, and other ablations in the LA (roof line, mitral isthmus line, posterior wall) |
Cryo-balloon: N = 12 (6.7 %); Multi-electrode duty-cycled phased radiofrequency ablation: N = 8 (4.5 %); Nonirrigated and open-irrigation radiofrequency catheters: N = 157 (88.7 %) |
3 months after ablation |
The more scarring overlaps fibrosis, the better the arrhythmia-free survival |
| Parmar et al., 20151515 Parmar BR, Jarrett TR, Kholmovski EG, Hu N, Parker D, MacLeod RS, et al. Poor scar formation after ablation is associated with atrial fibrillation recurrence. J Interv Card Electrophysiol. 2015;44(3):247-56.
|
RFCA |
PVI and additional debulking of the LA posterior wall |
3.5-mm ablation catheter |
3 months after ablation |
Poor scar formation on LGE-MRI was associated with higher rates of AF recurrence |
