Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation-a pilot study.

Autor:	Orbán G; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Dohy Z; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Suhai FI; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Nagy AI; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Salló Z; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Boga M; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Kiss M; Siemens Healthcare Hungary, Budapest, Hungary., Kunze K; MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom., Neji R; MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom., Botnar R; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.; Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile., Prieto C; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.; Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile., Gellér L; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Merkely B; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Vágó H; Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Szegedi N; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Jun 16; Vol. 10, pp. 1177347. Date of Electronic Publication: 2023 Jun 16 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1177347
Abstrakt:	Introduction: Left atrial appendage (LAA) thrombus is the most common source of embolization in atrial fibrillation (AF). Transesophageal echocardiography (TEE) is the gold standard method for LAA thrombus exclusion. Our pilot study aimed to compare the efficacy of a new non-contrast-enhanced cardiac magnetic resonance (CMR) sequence (BOOST) with TEE for the detection of LAA thrombus and to evaluate the usefulness of BOOST images for planning radiofrequency catheter ablation (RFCA) compared with left atrial (LA) contrast-enhanced computed tomography (CT). We also attempted to assess the patients' subjective experiences with TEE and CMR. Methods: Patients with AF undergoing either electrical cardioversion or RFCA were enrolled. Participants underwent pre-procedural TEE and CMR scans to evaluate LAA thrombus status and pulmonary vein anatomy. Patient experiences with TEE and CMR were assessed using a questionnaire developed by our team. Some patients scheduled for RFCA also had pre-procedural LA contrast-enhanced CT. In such cases, the operating physician was asked to subjectively define the quality of the CT and CMR scan on a scale of 1-10 (1 = worst, 10 = best) and comment on CMR's usefulness in RFCA planning. Results: Seventy-one patients were enrolled. In 94.4%, both TEE and CMR excluded, and in 1 patient, both modalities reported the presence of LAA thrombus. In 1 patient, TEE was inconclusive, but CMR excluded LAA thrombus. In 2 patients, CMR could not exclude the presence of thrombus, but in 1 of those cases, TEE was also indecisive. During TEE, 67%, during CMR, only 1.9% of patients reported pain ( p  < 0.0001), and 89% would prefer CMR in case of a repeat examination. The quality of the left atrial contrast-enhanced CT scans was better compared with the image quality of the CMR BOOST sequence [8 (7-9) vs. 6 (5-7), p  < 0.0001]. Still, the CMR images were useful for procedural planning in 91% of cases. Conclusion: The new CMR BOOST sequence provides appropriate image quality for ablation planning. The sequence might be useful for excluding larger LAA thrombi; however, its accuracy in detecting smaller thrombi is limited. Most patients preferred CMR over TEE in this indication. Competing Interests: KK, RN, and MK are employees of Siemens Healthineers. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 Orbán, Dohy, Suhai, Nagy, Salló, Boga, Kiss, Kunze, Neji, Botnar, Prieto, Gellér, Merkely, Vágó and Szegedi.)
Databáze:	MEDLINE
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