Abstract 16972: Abnormalities of the Aorta Are Common Following Pulmonary Vein Isolation: A Cardiac Magnetic Resonance Imaging Study
BACKGROUND: Esophageal injury has been reported following pulmonary vein isolation (PVI), but few data are known regarding involvement of other mediastinal structures such as the aorta. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR) has been used to identify myocardial fibrosis and inflammation, and may provide a way of identifying extramyocardial involvement. We sought to determine the frequency of aortic wall LGE post-PVI to examine potential aortic involvement.
METHODS: Consecutive patients who underwent their first PVI with pre and post-LGE CMR at our institution between 2009-2011 were retrospectively identified. Left atrial (LA) and aortic wall hyperenhancement were analyzed using a commercial workstation (QMass MR). LA and aortic hyperenhancement were defined as any evidence of LGE at 10 standard deviations (SD) greater than the mean signal intensity of the aortic blood pool. Studies were visually assessed for geometric contact between the LA and aorta.
RESULTS: Of 46 patient datasets meeting entry criteria, 9 were excluded due to poor quality CMR, leaving 37 patients (age 60.5 + 8.6 years, 68% male) and 74 studies for analysis. No patient had evidence of a clinical aortic complication. Aortic wall LGE was seen in 35% (13/37) pre-PVI and in 57% (21/37) post-PVI (p= 0.068). All (100%) patients with post-PVI aortic wall enhancement also had post-PVI LA hyperenhancement (Figure 1). The vast majority (85%) of patients with aortic wall LGE post-PVI had direct contact of the LA and aortic wall on the pre-PVI CMR study.
CONCLUSION: Aortic wall LGE is common post-PVI, with a universal finding of concomitant LA LGE in all patients with aortic enhancement. The vast majority of those with aortic LGE had direct contact of the left atrium and aorta. These data suggest that LGE CMR evidence of aortic involvement post-PVI is common. The clinical implications of this imaging abnormality remain to be defined.
- © 2011 by American Heart Association, Inc.