Terenz Escartin, Maria Terricabras, Calder Sheagren, Philippa Krahn, Idan Roifman, Graham Wright, Christopher C Cheung
{"title":"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。","authors":"Terenz Escartin, Maria Terricabras, Calder Sheagren, Philippa Krahn, Idan Roifman, Graham Wright, Christopher C Cheung","doi":"10.1016/j.hrthm.2025.06.024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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 T<sub>1</sub>w MRI has recently been shown to accurately characterize RFA lesions in preclinical models.</p><p><strong>Objective: </strong>To demonstrate the feasibility of wideband native T<sub>1</sub>w MRI in characterizing lesion dimensions in patients within 7-days of ventricular tachycardia (VT) radiofrequency ablation (RFA).</p><p><strong>Methods: </strong>Post-ablation wideband native T<sub>1</sub>w and 3D LGE MRI was performed within 7-days of RFA. RFA lesion surface area (mm<sup>2</sup>), volume (mm<sup>3</sup>), and native T<sub>1</sub>w 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.</p><p><strong>Results: </strong>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 T<sub>1</sub>w 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 T<sub>1</sub>w (r=0.71, p=0.0237; r=0.70, p=0.0265; p<0.05), respectively. Average maximum native T<sub>1</sub>w 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.</p><p><strong>Conclusion: </strong>Native T<sub>1</sub>w 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.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Feasibility Study: Characterizing Acute Lesion Dimensions in Patients With and Without Devices Using Non-Contrast (Native T<sub>1</sub>-weighted) MRI After VT/PVC Radiofrequency Ablation.\",\"authors\":\"Terenz Escartin, Maria Terricabras, Calder Sheagren, Philippa Krahn, Idan Roifman, Graham Wright, Christopher C Cheung\",\"doi\":\"10.1016/j.hrthm.2025.06.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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 T<sub>1</sub>w MRI has recently been shown to accurately characterize RFA lesions in preclinical models.</p><p><strong>Objective: </strong>To demonstrate the feasibility of wideband native T<sub>1</sub>w MRI in characterizing lesion dimensions in patients within 7-days of ventricular tachycardia (VT) radiofrequency ablation (RFA).</p><p><strong>Methods: </strong>Post-ablation wideband native T<sub>1</sub>w and 3D LGE MRI was performed within 7-days of RFA. RFA lesion surface area (mm<sup>2</sup>), volume (mm<sup>3</sup>), and native T<sub>1</sub>w 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.</p><p><strong>Results: </strong>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 T<sub>1</sub>w 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 T<sub>1</sub>w (r=0.71, p=0.0237; r=0.70, p=0.0265; p<0.05), respectively. Average maximum native T<sub>1</sub>w 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.</p><p><strong>Conclusion: </strong>Native T<sub>1</sub>w 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.</p>\",\"PeriodicalId\":12886,\"journal\":{\"name\":\"Heart rhythm\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.6000,\"publicationDate\":\"2025-06-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart rhythm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.hrthm.2025.06.024\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2025.06.024","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Feasibility Study: Characterizing Acute Lesion Dimensions in Patients With and Without Devices Using Non-Contrast (Native T1-weighted) MRI After VT/PVC Radiofrequency Ablation.
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.
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.
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