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Cardiovascular magnetic resonance guided electrophysiology studies.

Kolandaivelu A, Lardo AC, Halperin HR - J Cardiovasc Magn Reson (2009)

Bottom Line: Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance.In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation.Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD 21205, USA. akoland@jhmi.edu

ABSTRACT
Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.

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A) Example of the bipolar intracardiac electrograms during scanning before filtering (bottom trace) and after filtering (top trace). B) Example of bipolar intracardiac electrograms at various locations in the heart outside the scanner (left column) and during scanning with different levels of filtering (right column). RA = Right atrium, His = His bundle, RV = right ventricular apex.
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Figure 4: A) Example of the bipolar intracardiac electrograms during scanning before filtering (bottom trace) and after filtering (top trace). B) Example of bipolar intracardiac electrograms at various locations in the heart outside the scanner (left column) and during scanning with different levels of filtering (right column). RA = Right atrium, His = His bundle, RV = right ventricular apex.

Mentions: Subsequent work in our lab has demonstrated the ability to use real-time CMR to perform basic diagnostic EP studies [39]. Imaging was performed using an unmodified clinical scanner with interactive scan plane manipulation software to guide non-ferromagnetic catheters to standard electrogram recording sites including the high right atrium, His bundle, and right ventricular apex. Electrical interference from gradient switching was adequately suppressed by 30 Hz to 300 Hz bandpass filtering such that even the low voltage signal from the His bundle could be identified (Figure 4). Importantly, the study demonstrated that MR guided electrophysiology measurements could be performed safely in human subjects. The topic of device safety in the CMR environment is discussed further below.


Cardiovascular magnetic resonance guided electrophysiology studies.

Kolandaivelu A, Lardo AC, Halperin HR - J Cardiovasc Magn Reson (2009)

A) Example of the bipolar intracardiac electrograms during scanning before filtering (bottom trace) and after filtering (top trace). B) Example of bipolar intracardiac electrograms at various locations in the heart outside the scanner (left column) and during scanning with different levels of filtering (right column). RA = Right atrium, His = His bundle, RV = right ventricular apex.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2719626&req=5

Figure 4: A) Example of the bipolar intracardiac electrograms during scanning before filtering (bottom trace) and after filtering (top trace). B) Example of bipolar intracardiac electrograms at various locations in the heart outside the scanner (left column) and during scanning with different levels of filtering (right column). RA = Right atrium, His = His bundle, RV = right ventricular apex.
Mentions: Subsequent work in our lab has demonstrated the ability to use real-time CMR to perform basic diagnostic EP studies [39]. Imaging was performed using an unmodified clinical scanner with interactive scan plane manipulation software to guide non-ferromagnetic catheters to standard electrogram recording sites including the high right atrium, His bundle, and right ventricular apex. Electrical interference from gradient switching was adequately suppressed by 30 Hz to 300 Hz bandpass filtering such that even the low voltage signal from the His bundle could be identified (Figure 4). Importantly, the study demonstrated that MR guided electrophysiology measurements could be performed safely in human subjects. The topic of device safety in the CMR environment is discussed further below.

Bottom Line: Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance.In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation.Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD 21205, USA. akoland@jhmi.edu

ABSTRACT
Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.

Show MeSH
Related in: MedlinePlus