Characteristics Of The Ablation Lesions In Cardiac Magnetic Resonance Imaging After Radiofrequency Ablation Of Ventricular Arrhythmias In Relation To The Procedural Success

Background In human patients, studies about the cardiac magnetic resonance (CMR) appearance of the acute radiofrequency (RF) lesions in relation to the procedural outcomes after catheter ablation (CA) of ventricular arrhythmias (VA) are scarce. We aimed to investigate the RF lesions characteristics in relation to the procedural success.Methods Patients referred for ablation of VAreceivedCMR(1.5 T) using gadolinium contrast before and after ablation. CA in left ventricle was performed using a 3.5-mm irrigated catheter. The volume and transmurality of the RF-induced lesions were measured in early gadolinium-enhanced postablation CMRs. Acute failure was defined as persistently inducible VA at the end of the CA.Results Twenty-five patients (60.7 +/- 9.8 years, 19 with sustained ventricular tachycardia) were studied. All RF lesions had nonenhanced core. The volume of the nonenhanced lesions showed positive correlation with the maximal RF power (r = 0.598, P = .002) and the impedance drop (r = 0.416, P = .038). Patients with transmural (>= 75%) lesions had significantly larger impedance drop as compared to those with nontransmural lesions (<75%): 20.3 +/- 9.4 versus 13.5 +/- 4.3, P = .037. In the failures, the lesions volume was nonsignificantly larger: 3.86 +/- 3.3% versus 2.6 +/- 1.7%, P = .197; however, it was considerably deeper: 86 +/- 13% versus 62 +/- 26%, P = .03.Conclusions CMR after VA ablation showed nonenhanced lesions resembling the no-reflow phenomenon in myocardial infarction. Although the size and the depth of the RF injury correlated with the ablation energy and impedance drop, they were not associated with acute ablation success.