The use of novel 3D dark-blood late gadolinium enhancement MRI to determine the optimal threshold for atrial scar after pulmonary vein isolation ablation

Abstract Background Dark-blood late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is proved to be superior bright-blood LGE MRI in localising subtle subendocardial scar the ventricles, because of improved contrast between myocardial and blood. However, dark-blood has not yet been applied identify atrial left atrium (LA) therefore its threshold determine unknown. Purpose To optimal intensity for 3D ablation after pulmonary vein isolation (PVI) Methods Twelve re-do PVI patients with symptomatic fibrillation (AF) who underwent pre-procedural were included. The image ratio (IIR = normalized blood pool) from calculated using ADAS-AF. High-density bipolar voltages (BiV) maps recorded during sinus rhythm prior ablation. All BiV locations ≤5 mm ADAS LA anatomy compared corresponding IIR, custom-made software MATLAB. achieve an equal (BiV ≤0.15 mV) non-scar >0.15 each patient, pairs randomly resampled same number as pairs. This was repeated 10 times every random selection, receiver operating characteristics (ROC) analysis performed IIR (provided by Youden's index) defined <0.15 mV (Figure 1). thresholds areas under curve averaged overall performance threshold. Results Of 12 included patients, 8 had cryo PVI, 2 radiofrequency surgical/hybrid AF ROC estimated average predicting 1.106, a mean area (AUC) 0.73 Figure shows two examples map (A), (B), correspondence (C) providing information on spatial agreement BiV. individual qualitative assessment provides insight into variation techniques may facilitate future studies pathophysiological understanding scarring. Conclusion first study use novel whole heart evaluate PVI. Based analyses, 1.106 scar, high density voltage mV. Funding Acknowledgement Type funding sources: None.