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Optimizing fibrosis detection: a comparison of electroanatomical mapping and late enhancement gadolinium magnetic resonance imaging

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Fibrotic atrial cardiomyopathy plays an important role in determining the outcome of ablation in patients with atrial fibrillation (AF). Two main methods are being used for the evaluation of fibrosis: voltage-based high-density (HD) electroanatomical mapping (EAM) and late gadolinium enhancement MRI (LGE-MRI). The comparability between both methods in detecting fibrosis has not been systematically investigated.

Methods

LGE-MRIs of the left atrium (LA) were performed in 21 patients. LA-fibrosis was evaluated using a custom-designed software generating a 3D-model of the LA. HD-electroanatomical maps were recorded in each patient. After processing the maps and the MRI models by excluding the mitral valve, pulmonary veins, and the left atrial appendage, the LGE areas were measured and compared to the low voltage areas (LVA) in the HD maps using three different cutoff values of 0.5 mV, 0.7 mV, and 1.0 mV.

Results

The analysis revealed significant differences between EAM and LGE-MRI in assessing LA-fibrosis at 0.5-mV (for anterior and posterior walls) and 1.0-mV cutoffs (for anterior and posterior wall and septum). However, no significant differences were found between EAM and LGE-MRI when using a 0.7-mV cutoff for all the investigated areas.

Conclusions

A voltage cutoff of 0.7 mV provided the best correlation between EAM and LGE MRI for detecting left atrial fibrosis. It supports the idea that a 0.5-mV cutoff may underestimate fibrosis, as areas with local signal voltages between 0.6 and 0.8 mV could also show LGE on MRI. Further research is needed to determine the ideal voltage cutoff for detecting left atrial fibrosis.

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Data Availability

The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical considerations. However, they are available from the corresponding author upon reasonable request.

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Author information

Author notes

  1. P. Martin Bansmann and Yazan Mohsen contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Krankenhaus Porz am Rhein, Cologne, Germany

    P. Martin Bansmann

  2. Department of Cardiology, Electrophysiology and Rhythmology, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Cologne, Germany

    Yazan Mohsen, Marc Horlitz & Florian Stöckigt

  3. Clinical Sciences Malmö, Lund University, Lund, Sweden

    Yazan Mohsen

  4. Department of Internal Medicine II, University Hospital Bonn, 53125, Bonn, Germany

    Florian Stöckigt

Authors
  1. P. Martin Bansmann
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  2. Yazan Mohsen
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  3. Marc Horlitz
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  4. Florian Stöckigt
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Corresponding author

Correspondence to Yazan Mohsen.

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Ethical approval

The research protocol was approved by the Local Ethics Committee, in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Informed consent was obtained from all individual participants included in the study. As this study involved human participants and not animals, there are no animal welfare issues to address.

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Bansmann, P.M., Mohsen, Y., Horlitz, M. et al. Optimizing fibrosis detection: a comparison of electroanatomical mapping and late enhancement gadolinium magnetic resonance imaging. J Interv Card Electrophysiol 67, 571–577 (2024). https://doi.org/10.1007/s10840-023-01627-4

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  • DOI: https://doi.org/10.1007/s10840-023-01627-4

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