Perspective:

In contrast to some (but not all) earlier studies, this paper finds that LGE by CMR is not able to reliably distinguish electrically isolated versus reconnected sites in patients undergoing repeat ablation procedures for atrial fibrillation or atrial tachycardia. Significant challenges remain for LGE CMR of the atria: significant and variable artifacts can be present, there is no consensus for imaging timing after contrast and specific contrast agent and dose, image signal varies significantly between patients and prevents reliable quantification, CMR has limited spatial resolution for imaging the thin-walled atria, and co-registration of CMR and endocardial voltage maps remain challenging. Despite initial studies that were promising, this manuscript suggests that we need to go back to the drawing board and address these limitations, or try an alternative approach.