ArticleHeart rhythm O22026
Ablation lesion patterns in atrial fibrillation: A cardiac MRI comparison of different ablation strategies.
Article in Heart rhythm O2, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pulmonary vein (PV) isolation can be performed using various ablation strategies, including point-by-point radiofrequency (RF) and single-shot ablation techniques. However, the resulting lesion characteristics of these approaches are not yet fully understood. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) provides a noninvasive means to assess atrial ablation lesions. Objective: This study aimed to characterize ablation modality-specific left atrial LGE-CMR lesion patterns. Methods: Ablation lesion patterns of 42 patients were evaluated on LGE-CMR acquired 3 months after PV isolation was performed with point-by-point moderate-power moderate-duration RF, very-high-power short-duration RF, RF balloon, ultralow-temperature cryoablation, or pulsed field ablation (PFA). Left atrial LGE images were visually assessed and also postprocessed using the full-width half-maximum method for lesion quantification, with gap detection defined by a ≥40% threshold to assess lesion completeness. Results: Point-by-point RF ablation produced the most continuous LGE lesion patterns, whereas single-shot thermal techniques created broader but less continuous ablation lesions. PFA generated the widest and most heterogeneous patterns, with quantitative analysis confirming a high prevalence and large gap lengths in single-shot ablation groups, most prominently in the PFA group (total LGE encirclement: moderate-power moderate-duration 77.2% ± 10.1%; very-high-power short-duration 82.8% ± 12.4%; RF balloon 76.2% ± 11.6%; ultralow-temperature cryoablation 62.0% ± 9.9%; and PFA 60.2% ± 13.7%). Conclusion: LGE-CMR reveals modality-specific lesion patterns, with point-by-point RF showing the most continuous PV encirclement. PFA demonstrated variable lesion visualization, likely influenced by system differences and challenges in detecting nonthermal injury. The relationship between CMR-defined lesions and outcomes remains uncertain, underscoring the need for standardized imaging with emerging energy sources.
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