Volume 13, Issue 1, Pages (January 2016)

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Date of download: 5/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: New Magnetic Resonance Imaging-Based Method for.

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Volume 13, Issue 1, Pages 37-45 (January 2016) Contact force threshold for permanent lesion formation in atrial fibrillation ablation: A cardiac magnetic resonance–based study to detect ablation gaps David Andreu, MSc, PhD, Federico Gomez-Pulido, MD, Mireia Calvo, MSc, Alicia Carlosena-Remírez, BSc, Felipe Bisbal, MD, Roger Borràs, BSc, Eva Benito, MD, Eduard Guasch, MD, PhD, Susanna Prat-Gonzalez, MD, PhD, Rosario J. Perea, MD, PhD, Josep Brugada, MD, PhD, Antonio Berruezo, MD, PhD, Lluís Mont, MD, PhD Heart Rhythm Volume 13, Issue 1, Pages 37-45 (January 2016) DOI: 10.1016/j.hrthm.2015.08.010 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Eighteen-segment division of the pulmonary veins. B: Contact force (CF) electroanatomic map of the radiofrequency applications. B1: No gap is visible when a minimum CF (CF-min) value is set to 7 g (red color, <7 g; purple color, >7 g). B2: A gap can be observed in segments 2, 3, and 5 of the left pulmonary veins (white arrows) when a CF-min value is set to 9 g (red color, <9 g; purple color, >9 g). Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Two examples of 3-dimensional delayed-enhancement cardiac magnetic resonance (DE-CMR) reconstruction of the left atrium observed 3 months after the ablation procedure. A: DE-CMR reconstruction without gaps. B: Ablation gaps (white arrows) can be observed in the DE-CMR reconstruction from another patient. Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 A: Mean minimum contact force (CF-min) value and ablation gaps observed in the 3-dimensional delayed-enhancement cardiac magnetic resonance (DE-CMR) reconstruction for each pulmonary vein segment. In the majority of segments, a strong correlation was observed between the number of gaps and the mean CF-min value. B: Mean CF-min value in the pulmonary vein segments with a DE-CMR gap. C: Mean CF-min value in the pulmonary vein segments without a DE-CMR gap. Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 Receiver operating characteristic (ROC) analysis of the contact force (CF) threshold as a predictor of complete ablation line. A CF threshold of >8 g has a sensitivity of 72.9% and a specificity of 80.9%. With use of a CF threshold of >12 g, the sensitivity decreases to 58.7% but the specificity increases to 94.0% (area under the curve 0.834). Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 5 Analysis of arrhythmia-free left atrium of the studied population compared to the number of gaps observed in the 3-dimensional delayed-enhancement cardiac magnetic resonance reconstruction of the left atrium. A statistically significant difference can be observed between the 2 groups. Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 6 Side-by-side comparison of a contact force electroanatomic map and a 3-dimensional delayed-enhancement cardiac magnetic resonance (DE-CMR) reconstruction. A: Posterior-anterior view. B: Anterior-posterior view. A strong correlation between the ablation lesions observed in the DE-CMR reconstruction can also be observed in the contact force electroanatomic map (white arrows). In some areas, no lesion appears in the DE-CMR reconstruction even though a high contact force is achieved (blue arrow). Heart Rhythm 2016 13, 37-45DOI: (10.1016/j.hrthm.2015.08.010) Copyright © 2016 Heart Rhythm Society Terms and Conditions