Saturation recovery-prepared magnetic resonance angiography for assessment of left atrial and esophageal anatomy.

Publication Title

The British journal of radiology

Authors

Johannes Siebermair
Eugene G Kholmovski
Douglas Sheffer
Joyce Schroeder
Leif Jensen
Mobin Kheirkhahan
Alex A Baher
Majd M Ibrahim
Theresa Reiter
Tienush Rassaf
Reza Wakili
Nassir F Marrouche
Christopher J McGann, Swedish Heart and Vascular Institute, Seattle, WA, USAFollow
Brent D Wilson

Document Type

Article

Publication Date

7-1-2021

Keywords

washington; seattle; swedish heart

Abstract

OBJECTIVES: Magnetic resonance angiography (MRA) has been established as an important imaging method in cardiac ablation procedures. In pulmonary vein (PV) isolation procedures, MRA has the potential to minimize the risk of severe complications, such as atrio-esophageal fistula, by providing detailed information on esophageal position relatively to cardiac structures. However, traditional non-gated, first-pass (FP) MRA approaches have several limitations, such as long breath-holds, non-uniform signal intensity throughout the left atrium (LA), and poor esophageal visualization. The aim of this observational study was to validate a respiratory-navigated, ECG-gated (EC), saturation recovery-prepared MRA technique for simultaneous imaging of LA, LA appendage, PVs, esophagus, and adjacent anatomical structures.

METHODS: Before PVI, 106 consecutive patients with a history of AF underwent either conventional FP-MRA (

RESULTS: EC-MRA demonstrated significantly better image quality than FP-MRA in every quality category. Esophageal visibility using the new MRA technique was markedly better than with the conventional FP-MRA technique (median 3.5 [IQR 1]

CONCLUSION: Our ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality and esophageal visibility than the established non-gated, breath-holding FP-MRA. Image quality of EC-MRA technique has the additional advantage of being unaffected by heart rate.

ADVANCES IN KNOWLEDGE: Detailed information of cardiac anatomy has the potential to minimize the risk of severe complications and improve success rates in invasive electrophysiological studies. Our novel ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality of LA and esophageal structures than the traditional first-pass algorithm. This new MRA technique is robust to arrhythmia (tachycardic, irregular heart rates) frequently observed in AF patients.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Cardiology