Dark Regions of No-Reflow on LGE-MRI Result in Permanent Scar Post Atrial Fibrillation Ablation

Christopher J. McGann¹, Eugene G. Kholmovski¹, Joshua J. E. Blauer¹, Sathya Vijayakumar¹, Thomas S. Haslam¹, Joshua E. Cates¹, Nazem W. Akoum¹, Edward V. R. Dibella¹, Nathan S. Burgon¹, Alton J. Alexander¹, Marcelinus Prastawa¹, Dennis Parker¹, Rob MacLeod¹, Nassir F. Marrouche¹

When LGE imaging is performed immediately post-ablation, heterogeneous injury is seen with both bright (hyperenhancing) and dark (non-enhancing) lesions. The relationship between the acute injuries seen on LGE and late scar formation has not been well studied. Ten patients presenting for AF ablation underwent 3D LGE MRI immediately post ablation (IPA) and three months post-ablation (3moPA) on a 3T scanner. The IPA injuries were evaluated and categorized as either hyperenhancing (HE) or non-enhancing (NE) lesions and compared to scar 3moPA. The NE lesions demonstrate 'no-reflow' characteristics and may improve prediction of final scar at 3 months.