Pranav Bhagirath

86 Chapter 4 The outcome of the current investigation with regard to scar-maps, warrants further study towards the identification of a strategy to differentiate between electrically dormant gaps and gaps associated with the recurrence of AF. Limitations Various studies have compared the accuracy and suitability of multiple imaging modalities to image the parameters required for patient selection or procedural guidance of catheter ablation [4;5;16;17] . However, this is the first study that performs a comprehensive, single modality workup of patients undergoing ablation. Although the 8 patients included in this study can be considered as a lower limit for statistical evaluation, the results indicate the clinical applicability and feasibility of the proposed workflow. Although all scans were of diagnostic quality, factors such as irregular heart beat and inability to perform a breath-hold may cause artifacts that could limit the use of this technique. In addition, the CMR scanner field strength used in this study was 1.5 Tesla (T). It might be hypothesized that the increased magnet strength provided by a 3T scanner can be used to improve spatial resolution (image quality) or to reduce scan times. Future perspectives The proposed CMR protocol and post-processing methods can be performed and completed within a limited time period. This offers the prospect to implement this single modality workflow in a straightforward manner for the daily clinical routine. In addition, the technical knowledge required for image analysis is comparable to basic CMR post-processing. Although these factors facilitate rapid implementation, a larger prospective study to investigate the cost-efficiency and clinical efficacy of this approach is currently being planned and would support the rationale for routine clinical use. CONCLUSION A single modality, CMR based imaging workflow is clinically feasible, and suitable to perform patient selection and procedural guidance of AF ablation. Especially redo ablation procedures may benefit from a scar-map guided, targeted (patient-specific) ablation strategy. Future studies should investigate the cost-efficiency and efficacy of this workflow.