Diagnostic accuracy of cardiac magnetic resonance imaging in the detection and characterization of left atrial catheter ablation lesions: a multicenter experience

J Cardiovasc Electrophysiol. 2013 Apr;24(4):396-403. doi: 10.1111/jce.12063. Epub 2013 Jan 7.


Introduction: We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre- and postablation imaging.

Methods: Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre- or postablation, and if postablation, whether lesions were in an ostial or WACA distribution.

Results: LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000).

Conclusion: LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation / pathology
  • Atrial Fibrillation / surgery*
  • Catheter Ablation* / adverse effects
  • Chi-Square Distribution
  • Cicatrix / etiology
  • Cicatrix / pathology*
  • Contrast Media
  • Cryosurgery* / adverse effects
  • Female
  • Gadolinium DTPA
  • Heart Atria / pathology
  • Heart Atria / surgery
  • Humans
  • Image Interpretation, Computer-Assisted
  • Imaging, Three-Dimensional
  • Logistic Models
  • London
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Observer Variation
  • Odds Ratio
  • Predictive Value of Tests
  • Pulmonary Veins / pathology
  • Pulmonary Veins / surgery*
  • Reproducibility of Results
  • Treatment Outcome


  • Contrast Media
  • Gadolinium DTPA