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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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Example of non-contrast T2 weighted MR imaging of right ventricular epicardial RF ablation lesions with pathologic correlation. Stability of the imaged lesion size is demonstrated from 30 minutes to 12 hours after ablation. Figure included with permission from Heart Rhythm (Dickfeld HR 2007;4(2):215).
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Figure 5: Example of non-contrast T2 weighted MR imaging of right ventricular epicardial RF ablation lesions with pathologic correlation. Stability of the imaged lesion size is demonstrated from 30 minutes to 12 hours after ablation. Figure included with permission from Heart Rhythm (Dickfeld HR 2007;4(2):215).

Mentions: 500 kHz radiofrequency (RF) current is the most commonly used ablation source used for electrophysiology procedures. Cryothermy, ultrasound, laser, and microwave ablation are also being investigated. Ablation lesions can be visualized because CMR is able to detect specific changes in proton precession and relaxation properties resulting from heating and heat induced biophysical changes in cardiac tissue including interstitial edema, hyperemia, protein conformational changes, cellular shrinkage, and tissue coagulation [38]. Acute interstitial edema is likely responsible for the hyperintense region corresponding to the area of acute RF ablation damage observed by T2-weighted FSE imaging [38,45] (Figure 5). Dickfield and colleagues found that this hyperintense region correlated well with necrotic lesion size on gross pathology and also noted that gaps between lesions on imaging corresponded with lesion gaps on pathology [46]. Lesion visualization by T2 weighted imaging has been reported as soon as 2 minutes after ablation and stable imaging characteristics have been observed from 30 minutes to 12 hours post ablation [38,46]. This could make T2 weighted CMR a tool to evaluate lesions and lesion continuity over the course of an ablation procedure.


Cardiovascular magnetic resonance guided electrophysiology studies.

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

Example of non-contrast T2 weighted MR imaging of right ventricular epicardial RF ablation lesions with pathologic correlation. Stability of the imaged lesion size is demonstrated from 30 minutes to 12 hours after ablation. Figure included with permission from Heart Rhythm (Dickfeld HR 2007;4(2):215).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Example of non-contrast T2 weighted MR imaging of right ventricular epicardial RF ablation lesions with pathologic correlation. Stability of the imaged lesion size is demonstrated from 30 minutes to 12 hours after ablation. Figure included with permission from Heart Rhythm (Dickfeld HR 2007;4(2):215).
Mentions: 500 kHz radiofrequency (RF) current is the most commonly used ablation source used for electrophysiology procedures. Cryothermy, ultrasound, laser, and microwave ablation are also being investigated. Ablation lesions can be visualized because CMR is able to detect specific changes in proton precession and relaxation properties resulting from heating and heat induced biophysical changes in cardiac tissue including interstitial edema, hyperemia, protein conformational changes, cellular shrinkage, and tissue coagulation [38]. Acute interstitial edema is likely responsible for the hyperintense region corresponding to the area of acute RF ablation damage observed by T2-weighted FSE imaging [38,45] (Figure 5). Dickfield and colleagues found that this hyperintense region correlated well with necrotic lesion size on gross pathology and also noted that gaps between lesions on imaging corresponded with lesion gaps on pathology [46]. Lesion visualization by T2 weighted imaging has been reported as soon as 2 minutes after ablation and stable imaging characteristics have been observed from 30 minutes to 12 hours post ablation [38,46]. This could make T2 weighted CMR a tool to evaluate lesions and lesion continuity over the course of an ablation procedure.

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