26 results found
Ataollahi A, Karim R, Fallah AS, et al., 2016, Three-Degree-of-Freedom MR-Compatible Multisegment Cardiac Catheter Steering Mechanism, IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, Vol: 63, Pages: 2425-2435, ISSN: 0018-9294
Karim R, Bhagirath P, Claus P, et al., 2016, Evaluation of state-of-the-art segmentation algorithms for left ventricle infarct from late Gadolinium enhancement MR images, Medical Image Analysis, Vol: 30, Pages: 95-107, ISSN: 1361-8415
Williams SE, Harrison J, Chubb H, et al., 2015, The Effect of Contact Force in Atrial Radiofrequency Ablation, JACC: Clinical Electrophysiology, Vol: 1, Pages: 421-431, ISSN: 2405-500X
Arujuna A, Karim R, Zarinabad N, et al., 2015, A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation., Europace, Vol: 17, Pages: 1241-1250
AIMS: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. CONCLUSION: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.
Williams S, Harrison J, Chubb H, et al., The Effect of Contact Force in Atrial Radiofrequency Ablation : Electroanatomical, Cardiovascular Magnetic Resonance, and Histological Assessment in a Chronic Porcine Model, JACC: Clinical Electrophysiology
Harrison JL, Sohns C, Linton NW, et al., 2015, Response to letter from Bisbal et al regarding, "Repeat left atrial catheter ablation: cardiac magnetic resonance prediction of endocardial voltage and gaps in ablation lesion sets"., Circ Arrhythm Electrophysiol, Vol: 8, Pages: 754-755
Harrison JL, Sohns C, Linton NW, et al., 2015, Repeat left atrial catheter ablation: cardiac magnetic resonance prediction of endocardial voltage and gaps in ablation lesion sets., Circ Arrhythm Electrophysiol, Vol: 8, Pages: 270-278
BACKGROUND: Studies have reported an inverse relationship between late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) signal intensity and left atrial (LA) endocardial voltage after LA ablation. However, there is controversy regarding the reproducibility of atrial LGE CMR and its ability to identify gaps in ablation lesions. Using systematic and objective techniques, this study examines the correlation between atrial CMR and endocardial voltage. METHODS AND RESULTS: Twenty patients who had previous ablation for atrial fibrillation and represented with paroxysmal atrial fibrillation or atrial tachycardia underwent preablation LGE CMR. During the ablation procedure, high-density point-by-point Carto voltage maps were acquired. Three-dimensional CMR reconstructions were registered with the Carto anatomies to allow comparison of voltage and LGE signal intensity. Signal intensities around the left and right pulmonary vein antra and along the LA roof and mitral lines on the CMR-segmented LA shells were extracted to examine differences between electrically isolated and reconnected lesions. There were a total of 6767 data points across the 20 patients. Only 119 (1.8%) of the points were ≤ 0.05 mV. There was only a weak inverse correlation between either unipolar (r = -0.18) or bipolar (r = -0.17) voltage and LGE CMR signal intensities with low voltage occurring across a large range of signal intensities. Signal intensities were not statistically different for electrically isolated and reconnected lesions. CONCLUSIONS: This study demonstrates that there is only a weak point-by-point relationship between LGE CMR and endocardial voltage in patients undergoing repeat LA ablation. Using an objective method of assessing gaps in ablation lesions, LGE CMR is unable to reliably predict sites of electrical conduction.
Bhagirath P, van der Graaf M, Karim R, et al., 2015, Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation., Circ Arrhythm Electrophysiol, Vol: 8, Pages: 203-211
Bhagirath P, van der Graaf AWM, Karim R, et al., 2014, Multimodality imaging for patient evaluation and guidance of catheter ablation for atrial fibrillation — Current status and future perspective, International Journal of Cardiology, Vol: 175, Pages: 400-408, ISSN: 0167-5273
Harrison JL, Jensen HK, Peel SA, et al., 2014, Cardiac magnetic resonance and electroanatomical mapping of acute and chronic atrial ablation injury: a histological validation study., Eur Heart J, Vol: 35, Pages: 1486-1495
AIMS: To provide a comprehensive histopathological validation of cardiac magnetic resonance (CMR) and endocardial voltage mapping of acute and chronic atrial ablation injury. METHODS AND RESULTS: 16 pigs underwent pre-ablation T2-weighted (T2W) and late gadolinium enhancement (LGE) CMR and high-density voltage mapping of the right atrium (RA) and both were repeated after intercaval linear radiofrequency ablation. Eight pigs were sacrificed following the procedure for pathological examination. A further eight pigs were recovered for 8 weeks, before chronic CMR, repeat RA voltage mapping and pathological examination. Signal intensity (SI) thresholds from 0 to 15 SD above a reference SI were used to segment the RA in CMR images and segmentations compared with real lesion volumes. The SI thresholds that best approximated histological volumes were 2.3 SD for LGE post-ablation, 14.5 SD for T2W post-ablation and 3.3 SD for LGE chronically. T2-weighted chronically always underestimated lesion volume. Acute histology showed transmural injury with coagulative necrosis. Chronic histology showed transmural fibrous scar. The mean voltage at the centre of the ablation line was 3.3 mV pre-ablation, 0.6 mV immediately post-ablation, and 0.3 mV chronically. CONCLUSION: This study presents the first histopathological validation of CMR and endocardial voltage mapping to define acute and chronic atrial ablation injury, including SI thresholds that best match histological lesion volumes. An understanding of these thresholds may allow a more informed assessment of the underlying atrial substrate immediately after ablation and before repeat catheter ablation for atrial arrhythmias.
Karim R, Ma Y, Jang M, et al., 2014, Surface flattening of the human left atrium and proof-of-concept clinical applications, Computerized Medical Imaging and Graphics, Vol: 38, Pages: 251-266, ISSN: 0895-6111
Sohns C, Karim R, Harrison J, et al., 2014, Quantitative Magnetic Resonance Imaging Analysis of the Relationship Between Contact Force and Left Atrial Scar Formation After Catheter Ablation of Atrial Fibrillation, JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Vol: 25, Pages: 138-145, ISSN: 1045-3873
Ravanelli D, dal Piaz EC, Centonze M, et al., 2014, A Novel Skeleton Based Quantification and 3-D Volumetric Visualization of Left Atrium Fibrosis Using Late Gadolinium Enhancement Magnetic Resonance Imaging, IEEE Transactions on Medical Imaging, Vol: 33, Pages: 566-576, ISSN: 0278-0062
Karim R, Arujuna A, Housden RJ, et al., 2014, A Method to Standardize Quantification of Left Atrial Scar From Delayed-Enhancement MR Images., IEEE J Transl Eng Health Med, Vol: 2, ISSN: 2168-2372
Delayed-enhancement magnetic resonance imaging (DE-MRI) is an effective technique for detecting left atrial (LA) fibrosis both pre and postradiofrequency ablation for the treatment of atrial fibrillation. Fixed thresholding models are frequently utilized clinically to segment and quantify scar in DE-MRI due to their simplicity. These methods fail to provide a standardized quantification due to interobserver variability. Quantification of scar can be used as an endpoint in clinical studies and therefore standardization is important. In this paper, we propose a segmentation algorithm for LA fibrosis quantification and investigate its performance. The algorithm was validated using numerical phantoms and 15 clinical data sets from patients undergoing LA ablation. We demonstrate that the approach produces good concordance with expert manual delineations. The method offers a standardized quantification technique for evaluation and interpretation of DE-MRI scans.
Karim R, Housden RJ, Balasubramaniam M, et al., 2013, Evaluation of current algorithms for segmentation of scar tissue from late Gadolinium enhancement cardiovascular magnetic resonance of the left atrium: an open-access grand challenge, JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, Vol: 15, ISSN: 1097-6647
Malcolme-Lawes LC, Juli C, Karim R, et al., 2013, Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: A 2-center study, HEART RHYTHM, Vol: 10, Pages: 1184-1191, ISSN: 1547-5271
Puntmann VO, Voigt T, Chen Z, et al., 2013, Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy., JACC Cardiovasc Imaging, Vol: 6, Pages: 475-484
OBJECTIVES: The aim of this study was to examine the value of native and post-contrast T1 relaxation in the differentiation between healthy and diffusely diseased myocardium in 2 model conditions, hypertrophic cardiomyopathy and nonischemic dilated cardiomyopathy. BACKGROUND: T1 mapping has been proposed as potentially valuable in the quantitative assessment of diffuse myocardial fibrosis, but no studies to date have systematically evaluated its role in the differentiation of healthy myocardium from diffuse disease in a clinical setting. METHODS: Consecutive subjects undergoing routine clinical cardiac magnetic resonance at King's College London were invited to participate in this study. Groups were based on cardiac magnetic resonance findings and consisted of subjects with known hypertrophic cardiomyopathy (n = 25) and nonischemic dilated cardiomyopathy (n = 27). Thirty normotensive subjects with low pre-test likelihood of cardiomyopathy, not taking any regular medications and with normal cardiac magnetic resonance findings including normal left ventricular mass indexes, served as controls. Single equatorial short-axis slice T1 mapping was performed using a 3-T scanner before and at 10, 20, and 30 minutes after the administration of 0.2 mmol/kg of gadobutrol. T1 values were quantified within the septal myocardium (T1 native), and extracellular volume fractions (ECV) were calculated. RESULTS: T1 native was significantly longer in patients with cardiomyopathy compared with control subjects (p < 0.01). Conversely, post-contrast T1 values were significantly shorter in patients with cardiomyopathy at all time points (p < 0.01). ECV was significantly higher in patients with cardiomyopathy compared with controls at all time points (p < 0.01). Multivariate binary logistic regression revealed that T1 native could differentiate between healthy and diseased myocardium with sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 98% (area under the curve 0
Arujuna A, Karim R, Caulfield D, et al., 2012, Acute pulmonary vein isolation is achieved by a combination of reversible and irreversible atrial injury after catheter ablation: evidence from magnetic resonance imaging., Circ Arrhythm Electrophysiol, Vol: 5, Pages: 691-700
BACKGROUND: Pulmonary vein reconnection after pulmonary vein isolation is common and is usually associated with recurrences of atrial fibrillation. We used cardiac magnetic resonance imaging after radiofrequency ablation to investigate the hypothesis that acute pulmonary vein isolation results from a combination of irreversible and reversible atrial injury. METHODS AND RESULTS: Delayed enhancement (DE; representing areas of acute tissue injury/necrosis) and T2-weighted (representing tissue water content, including edema) cardiac magnetic resonance scans were performed before, immediately after (acute), and later than 3 months (late) after pulmonary vein isolation in 25 patients with paroxysmal atrial fibrillation undergoing wide-area circumferential ablation. Images were analyzed as pairs of pulmonary veins to quantify the percentage of circumferential antral encirclement composed of DE, T2, and combined DE+T2 signal. Fourteen of 25 patients were atrial fibrillation free at 11-month follow-up (interquartile range, 8-16 months). These patients had higher DE (71±6.0%) and lower T2 signal (72±7.8%) encirclement on the acute scans compared with recurrences (DE, 55±9.1%; T2, 85±6.3%; P<0.05). Patients maintaining sinus rhythm had a lesser decline in DE between acute and chronic scans compared with recurrences (71±6.0% and 60±5.8% versus 55±9.1% and 34±7.3%, respectively). The percentage of encirclement by a combination of DE+T2 was almost similar in both groups on the acute scans (atrial fibrillation free, 89±5.4%; recurrences, 92±4.8%) but different on the chronic scans (60±5.7% versus 34±7.3%). CONCLUSIONS: The higher T2 signal on acute scans and greater decline in DE on chronic imaging in patients with recurrences suggest that they have more reversible tissue injury, providing a potential mechanism for pulmonary vein reconnection, resulting in arrhythmia recurrence.
Malcolme-Lawes L, Juli C, Karim R, et al., 2012, AUTOMATED ANALYSIS OF ATRIAL DELAYED ENHANCEMENT CARDIAC MRI CORRELATES WITH VOLTAGE, AF RECURRENCE POST-ABLATION, AND HIGH STROKE RISK, Annual Conference of the British-Cardiovascular-Society (BCS)
Karim R, Arujuna A, Brazier A, et al., 2012, Validation of a novel method for the automatic segmentation of left atrial scar from delayed-enhancement magnetic resonance, Pages: 254-262, ISSN: 0302-9743
Delayed-enhancement magnetic resonance imaging is an effective technique for imaging left atrial (LA) scars both pre- and post- radio-frequency ablation for the treatment of atrial fibrillation. Existing techniques for LA scar segmentation require expert manual interaction, making them tedious and prone to high observer variability. In this paper, a novel automatic segmentation algorithm for segmenting LA scar was validated using digital phantoms and clinical data from 11 patients. The performance of the approach was compared to the two leading semi-automatic techniques and the ground truth of manual segmentations by 2 expert observers. The novel approach was shown to be accurate in terms of Dice coefficient, robust to typical image intensity variability, and much faster in terms of execution time. © 2012 Springer-Verlag.
Malcolme-Lawes LC, Karim R, Juli C, et al., 2011, Automated analysis of post-ablation atrial enhancement using delayed-enhanced cardiac magnetic resonance imaging, EUROPEAN HEART JOURNAL, Vol: 32, Pages: 629-629, ISSN: 0195-668X
Malcolme-Lawes L, Karim R, Juli C, et al., 2011, AUTOMATED ANALYSIS OF ATRIAL ABLATION-SCAR USING DELAYED-ENHANCED CARDIAC MRI, Annual Conference of the British-Cardiovascular-Society (BCS)
Karim R, Arujuna A, Brazier A, et al., 2011, Automatic Segmentation of Left Atrial Scar from Delayed-Enhancement Magnetic Resonance Imaging, 6th International Conference on Functional Imaging and Modeling of the Heart (FIMH), Publisher: SPRINGER-VERLAG BERLIN, Pages: 63-70, ISSN: 0302-9743
Karim R, Juli C, Malcolme-Lawes L, et al., 2010, Automatic Segmentation of Left Atrial Geometry from Contrast-Enhanced Magnetic Resonance Images Using a Probabilistic Atlas, 1st International Workshop on Statistical Atlases and Computational Models of the Heart, Publisher: SPRINGER-VERLAG BERLIN, Pages: 134-+, ISSN: 0302-9743
Karim R, Rueckert D, Mohiaddin R, et al., 2009, AUTOMATIC EXTRACTION OF THE LEFT ATRIAL ANATOMY FROM MR FOR ATRIAL FIBRILLATION ABLATION, IEEE International Symposium on Biomedical Imaging - From Nano to Macro, Publisher: IEEE, Pages: 502-+
Karim R, Mohiaddin R, Rueckert D, 2008, Left atrium segmentation for atrial fibrillation ablation, Medical Imaging 2008 Conference, Publisher: SPIE-INT SOC OPTICAL ENGINEERING, ISSN: 0277-786X
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