Combined single-session cardiovascular magnetic resonance: Stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation patients with chest pain syndromes prior to catheter ablation

Abstract

Aims: To determine the clinical utility of a combined single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating adenosine stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation (AF) patients referred for pulmonary vein isolation (PVI) and complaining about chest pain syndromes. Methods and results: The preprocedural CMR examination (adenosine stress perfusion, late gadolinium enhancement, and three-dimensional pulmonary vein angiography) was performed in 357 consecutive AF patients with chest pain syndromes referred for PVI. Stress perfusion results were used for stratification: ischaemia positive patients underwent invasive coronary angiography, ischaemia negative patients underwent PVI, and follow-up/outcome data were collected (combined primary endpoint of cardiac death/non-fatal myocardial infarction). The integrated CMR protocol had a high success rate (356/357, 99.7%), a short total examination duration (<30 min in all patients), and delivered high-quality three-dimensional pulmonary vein angiography in all patients undergoing PVI (324/324, 100%). Variants of pulmonary vein anatomy were identified in 33% of all patients (117/357). Stress positivity (28/356, 8%) had a high positive predictive value for identification of obstructive coronary artery disease (86%), while stress negativity carried a low short-term event rate following PVI (cumulative 1-year event-free survival rate, 99.6%). Conclusion: Combined single-session CMR as a routine diagnostic workup for AF patients with chest pain syndromes prior to PVI proved to represent a time-efficient and effective stratification tool.