Feasibility Study: Characterizing Acute Lesion Dimensions in Patients With and Without Devices Using Non-Contrast (Native T₁-weighted) MRI After VT/PVC Radiofrequency Ablation.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-06-20 DOI:10.1016/j.hrthm.2025.06.024

Terenz Escartin, Maria Terricabras, Calder Sheagren, Philippa Krahn, Idan Roifman, Graham Wright, Christopher C Cheung

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引用次数: 0

Abstract

Background: Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) has been shown to reliably locate RFA lesions with microvascular obstruction (MVO) as a broadly accepted signature. However, MVO volume depends on the time elapsed after gadolinium contrast injection. Native T₁w MRI has recently been shown to accurately characterize RFA lesions in preclinical models.

Objective: To demonstrate the feasibility of wideband native T₁w MRI in characterizing lesion dimensions in patients within 7-days of ventricular tachycardia (VT) radiofrequency ablation (RFA).

Methods: Post-ablation wideband native T₁w and 3D LGE MRI was performed within 7-days of RFA. RFA lesion surface area (mm²), volume (mm³), and native T₁w maximum lesion depth were calculated. Average catheter contact force (g), ablation duration (s) and impedance drop (Ω) were calculated. Patients with and without implantable cardioverter defibrillators (ICDs) were included.

Results: 10 patients (median age 64.5 years, 60% ischemic) underwent VT RFA (80% endocardial, 20% epicardial RFA), and post-ablation cardiac MRI within 7-days of RFA (median 4.5 days). There was a significantly greater mean MVO surface area and volume compared to mean native T₁w lesion surface area and volume (p=0.0108, p=0.0376; p<0.05), respectively. There were strong positive correlations between average surface area and average volume measured by MVO and native T₁w (r=0.71, p=0.0237; r=0.70, p=0.0265; p<0.05), respectively. Average maximum native T₁w lesion depth correlated with average ablation duration and average impedance drop (r=0.73, p=0.02; r=0.68, p=0.04, p<0.05), respectively.

Conclusion: Native T₁w MRI can effectively characterize lesion dimensions in patients with and without ICDs within 7 days post-ablation. This emerging biomarker may facilitate early prediction of RFA efficacy and ablation success particularly in patients demonstrating contraindications to gadolinium contrast agents.

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可行性研究：在VT/PVC射频消融术后，使用非对比（原生t1加权）MRI对有无器械患者的急性病变尺寸进行表征。

背景：晚期钆增强（LGE）磁共振成像（MRI）已被证明可以可靠地定位带有微血管阻塞（MVO）的RFA病变，这是一种广泛接受的特征。然而，MVO体积取决于注射钆造影剂后经过的时间。原生T1w MRI最近被证明可以准确地表征临床前模型中的RFA病变。目的：探讨宽带原生T1w MRI在室性心动过速（VT）射频消融（RFA）患者7天内病变尺寸表征的可行性。方法：消融后7天内进行宽带原生T1w和3D LGE MRI检查。计算RFA病变表面积（mm2）、体积（mm3）和原生T1w最大病变深度。计算导管平均接触力(g)、消融时间(s)和阻抗下降（Ω）。包括有和没有植入式心律转复除颤器（ICDs）的患者。结果：10例患者（中位年龄64.5岁，60%缺血）接受了VT RFA(80%心内膜RFA， 20%心外膜RFA)，并在RFA后7天内（中位4.5天）进行了消融后心脏MRI。MVO的平均表面积和体积明显大于T1w原发病灶的平均表面积和体积(p=0.0108, p=0.0376；P1w (r=0.71, p=0.0237；r = 0.70, p = 0.0265;P1w病变深度与平均消融时间、平均阻抗下降相关(r=0.73, p=0.02；r=0.68, p=0.04， p结论：原生T1w MRI能有效表征有或无icd患者消融后7天内病变的大小。这种新兴的生物标志物可能有助于RFA疗效和消融成功的早期预测，特别是在有钆造影剂禁忌症的患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.