Color Atlas and Synopsis of Electrophysiology by Emile Daoud & Steven Kalbfleisch

Author:Emile Daoud & Steven Kalbfleisch [Daoud, Emile]
Language: eng
Format: mobi
Publisher: McGraw-Hill Education
Published: 2015-04-20T22:00:00+00:00

40 TECHNOLOGIES FOR ABLATION OF ATRIAL FIBRILLATION: MRI ANALYSIS OF ATRIAL TISSUE REMODELING AND SCARRING

Matthias Koopmann, MD, Nazem Akoum, MD, MS, Nassir Marrouche, MD

CASE PRESENTATION

CASE 1

A 75-year-old woman with paroxysmal atrial fibrillation (AF) presented to our clinic for evaluation. The patient had been having AF for a few years. During AF episodes, she has palpitations and an irregular heart beat. Recently, the frequency of her episodes increased, and antiarrhythmic drug therapy with sotalol and flecainide failed to satisfactorily improve her symptoms, so she presents to discuss further treatment options. No significant comorbidities were apparent. A CHADS2 score of 1 (age) and a transthoracic echocardiogram showed normal left ventricular systolic function. Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) demonstrated 12% LA tissue fibrosis, consistent with Utah stage II (Figure 40-1). After careful consideration and because of severe symptoms associated with AF, the patient elected to undergo an AF ablation. Given an early disease stage, the ablation procedure was limited to pulmonary vein antrum isolation (PVAI) only. Repeat LGE-MRI 10 months postablation demonstrated 12.5% LA scar formation (see Figure 40-1). After follow-up of 15 months, the patient remains free of AF.

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