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Cardiac electrophysiology (EP) has rapidly evolved in recent decades from targeting simple arrhythmias such as accessory pathway or nodal re-entry tachycardia to the ablation of more complex substrates. This evolution has been possible due to a better understanding of the anatomical basis, and hence the mechanism, of more complex cardiac arrhythmias. Imaging of the heart has played an important role in defining cardiac structures and characterising the arrhythmic substrates. In this regard, MRI has provided the most comprehensive evaluation of cardiac anatomy, function, and tissue characterisation, and has made a major contribution to the increase in ablation procedures. This article provides a comprehensive overview of the role of MRI in the management of the most common complex arrhythmias: atrial fibrillation (AF) and ventricular tachycardia (VT).
Role of MRI in the management of patients undergoing AF ablation
AF is the most common arrhythmia in clinical practice and is associated with increased morbidity, mortality, and health care burden.w1 Catheter ablation has become the standard of care during the past decade for symptomatic drug refractory AF.w2 Although this treatment option has been amply demonstrated to improve symptoms and quality of life compared with medical treatment, the mid and long term success rate is still moderate.w3 w4 The EP community has made a great effort to further improve the results of AF ablation by designing new ablation techniques, identifying new ablation targets, and optimising the selection of candidates. In this regard, MRI offers the possibility to evaluate the pathologic substrate and better define the left atrial (LA) structural remodelling, which is closely related to procedural outcome. Evaluation of the LA remodelling after the ablation procedure helps to identify responders presenting a favourable remodelling, which is characterised by a reduction in size and recovery of shape. Additionally, this imaging modality can identify myocardial scarring related to radiofrequency lesions, which provides a non-invasive assessment …
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