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Updated: Dec 31, 2025
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Optimal timing of contrast-enhanced three-dimensional magnetic resonance left atrial angiography before pulmonary
Susanne Löbe1, Claudia Leuthäusser2, Alexander Pölkow2
1Department of Electrophysiology, HELIOS Heart Center Leipzig - University of Leipzig, Germany. Susanneloebe@hotmail.com.
Insights
Predicting contrast agent travel time for cardiovascular magnetic resonance pulmonary vein angiography is challenging. Real-time assessment is crucial for high-quality imaging before atrial fibrillation ablation.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- High image quality in cardiovascular magnetic resonance (CMR) pulmonary vein (PV) angiography is essential prior to atrial fibrillation catheter ablation.
- Optimal timing of the angiographic sequence during contrast agent passage is critical for achieving this quality.
- This study aimed to identify cardiovascular parameters that predict contrast agent travel time.
Purpose of the Study:
- To identify influential cardiovascular parameters for predicting contrast agent travel time in CMR PV angiography.
- To improve the accuracy of scan timing for enhanced image quality in patients undergoing atrial fibrillation ablation.
Main Methods:
- 106 patients underwent 3D contrast-enhanced PV angiography with real-time bolus tracking before catheter ablation.
- Scan timing was assessed by signal enhancement in the pulmonary artery, left atrium, and aorta.
- Evaluated parameters included ventricular function, atrial dimensions, valve insufficiencies, and pulmonary artery diameter.
Main Results:
- Optimal scan timing correlated with maximal left atrial signal enhancement.
- Contrast agent travel time varied widely (12-42 s, mean 18 ± 4 s).
- Left- and right-ventricular function were independent predictors on multivariate analysis, but models showed poor predictive fit (adjusted R2 = 27.5%).
Conclusions:
- Cardiovascular magnetic resonance (CMR) pulmonary vein (PV) angiography requires real-time assessment for optimal contrast timing.
- Ventricular function influences contrast agent travel time, but prediction models are currently inadequate.
- Visual determination of individual contrast passage time is necessary for consistent high-quality CMR imaging prior to ablation procedures.
Background:
To achieve high image quality of cardiovascular magnetic resonance (CMR) pulmonary vein (PV) angiography prior catheter ablation in patients with atrial fibrillation, optimal timing of the angiographic sequence during contrast agent passage is important. The present study identified influential cardiovascular parameters for prediction of contrast agent travel time.
Methods:
One hundred six consecutive patients underwent a CMR examination including three-dimensional (3D) contrast-enhanced PV angiography with real-time bolus tracking prior to catheter ablation. Correct scan timing was characterized by relative signal enhancement measurements in the pulmonary artery, left atrium (LA), and ascending aorta. Furthermore, left- and right-ventricular function, left- and right-atrial dimensions, presence of mitral or tricuspid insufficiencies, and main pulmonary artery diameter were determined.
Results:
The highest relative signal enhancement in LA demonstrated optimal scan timing. Contrast agent travel time showed wide variability (range: 12-42 s; mean: 18 ± 4 s). On univariate analysis, most cardiovascular parameters correlated with contrast agent travel time while on multivariate analysis left- and right-ventricular function remained the only independent predictors, but overall a poor fit to the data (adjusted R2, 27.5%) was found.
Conclusions:
Contrast agent travel time was mainly influenced by left- and right-ventricular function but prediction models poorly fitted the data. Thus, 3D PV angiography prior to PV ablation procedures necessitates real-time assessment, with visual determination of individual contrast agent passage time to ensure consistently high CMR image quality.
