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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 using automatic catheter highlighting and reference image planes to navigate complex 3-D anatomy using real-time CMR. The anatomic location of the catheter position on the image labeled LAX2 is better appreciated when overlaid with long and short axis images of the heart. Figure included with permission from The Journal of Magnetic Resonance Imaging (Guttman JMRI 2007; 26:1429).
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Figure 7: Example of using automatic catheter highlighting and reference image planes to navigate complex 3-D anatomy using real-time CMR. The anatomic location of the catheter position on the image labeled LAX2 is better appreciated when overlaid with long and short axis images of the heart. Figure included with permission from The Journal of Magnetic Resonance Imaging (Guttman JMRI 2007; 26:1429).

Mentions: The ability to generate real-time images with arbitrary orientations in addition to anatomically detailed 3-D images with flexible tissue contrast makes CMR well suited for navigating complex arrhythmia anatomy and delineating complex ablation patterns. This flexibility also introduces the potential for disorientation and information overload. Appropriate displays and user-interfaces tailored to the workflow of an EP procedure are needed to manage this flexibility. Because thin-slice real-time imaging can intersect anatomy in unfamiliar ways, 3-D visualizations that plot real-time images oriented relative to reference images can be helpful (Figure 7). A basic imaging interface for MR-guided EP procedures would provide a convenient way to "bookmark" and access reference cardiac views, switch between real-time and lesion visualization sequences during the procedure, appropriately present lesion images for ablation line continuity assessment, and display the relationship of stored images, catheter position, and intracardiac electrograms characteristics in 3-D.


Cardiovascular magnetic resonance guided electrophysiology studies.

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

Example of using automatic catheter highlighting and reference image planes to navigate complex 3-D anatomy using real-time CMR. The anatomic location of the catheter position on the image labeled LAX2 is better appreciated when overlaid with long and short axis images of the heart. Figure included with permission from The Journal of Magnetic Resonance Imaging (Guttman JMRI 2007; 26:1429).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Example of using automatic catheter highlighting and reference image planes to navigate complex 3-D anatomy using real-time CMR. The anatomic location of the catheter position on the image labeled LAX2 is better appreciated when overlaid with long and short axis images of the heart. Figure included with permission from The Journal of Magnetic Resonance Imaging (Guttman JMRI 2007; 26:1429).
Mentions: The ability to generate real-time images with arbitrary orientations in addition to anatomically detailed 3-D images with flexible tissue contrast makes CMR well suited for navigating complex arrhythmia anatomy and delineating complex ablation patterns. This flexibility also introduces the potential for disorientation and information overload. Appropriate displays and user-interfaces tailored to the workflow of an EP procedure are needed to manage this flexibility. Because thin-slice real-time imaging can intersect anatomy in unfamiliar ways, 3-D visualizations that plot real-time images oriented relative to reference images can be helpful (Figure 7). A basic imaging interface for MR-guided EP procedures would provide a convenient way to "bookmark" and access reference cardiac views, switch between real-time and lesion visualization sequences during the procedure, appropriately present lesion images for ablation line continuity assessment, and display the relationship of stored images, catheter position, and intracardiac electrograms characteristics in 3-D.

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