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Interactive real-time mapping and catheter ablation of the cavotricuspid isthmus guided by magnetic resonance imaging in a porcine model.

Hoffmann BA, Koops A, Rostock T, Müllerleile K, Steven D, Karst R, Steinke MU, Drewitz I, Lund G, Koops S, Adam G, Willems S - Eur. Heart J. (2009)

Bottom Line: Catheter position and movement during manipulation were continuously visualized during the entire intervention.Two porcine prematurely died due to VT/VF.In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology/Electrophysiology, University Hospital Eppendorf, University Heart Center, Martinistr 52, D-20246 Hamburg, Germany. b.hoffmann@uke.de

ABSTRACT

Aims: We investigated the feasibility of real-time magnetic resonance imaging (RTMRI) guided ablation of the cavotricuspid isthmus (CTI) by using a MRI-compatible ablation catheter.

Methods and results: Cavotricuspid isthmus ablation was performed in an interventional RTMRI suite by using a novel 7 French, steerable, non-ferromagnetic ablation catheter in a porcine in vivo model (n = 20). The catheter was introduced and navigated by RTMRI visualization only. Catheter position and movement during manipulation were continuously visualized during the entire intervention. Two porcine prematurely died due to VT/VF. Anatomical completion of the CTI ablation line could be achieved after a mean of 6.3+/-3 RF pulses (RF energy: 1807+/-1016.4 Ws/RF pulse, temperature: 55.9+/-5.9 degrees C) in n = 18 animals. In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab.

Conclusion: Completely non-fluoroscopic ablation guided by RTMRI using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology.

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(A) Pre- and (B) post-ablational T2-weighted turbo spin echo sequence showing focal hyperintensity (arrows) in the CTI region (RV, right ventricle; LA, left atrium; LV, left ventricle; ICV, inferior caval vein).
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EHP460F4: (A) Pre- and (B) post-ablational T2-weighted turbo spin echo sequence showing focal hyperintensity (arrows) in the CTI region (RV, right ventricle; LA, left atrium; LV, left ventricle; ICV, inferior caval vein).

Mentions: The ablation procedure duration within the MRI was 154.8 ± 24.2 min. There was a significant difference between the first and the last 10 ablation procedures (174.0 ± 17.6 vs. 135.7 ± 10.7 min, P < 0.001). The ablation catheter was safely visualized throughout the steering manoeuvre in the interventional procedure, yielding hyperintensity at its distal portion owing to the integrated visualization coil (Figure 3A–C). CTI and adjacent cardiac structures were reliably identified by MRI in all cases. The catheter was successfully placed in the inferior region of the tricuspid valve annulus in all animals. Continuous real-time imaging during each 60 s period of RF ablation allowed constant monitoring of the actual ablation electrode position. An anatomically oriented lesion line (T2-weighted TSE sequence) was achieved after a mean number of 6.3 ± 3 RF pulses (energy: 1807 ± 1016.4 Ws/RF pulse, temperature: 55.9 ± 5.9°C, impedance: 106.9 ± 13.3 Ohm). The TSE sequences for the depiction of focal oedema at the target regions did show a relative swelling and focal hyperintensity; however, not every single focal ablation site could be visualized in detail (Figure 4A and B).


Interactive real-time mapping and catheter ablation of the cavotricuspid isthmus guided by magnetic resonance imaging in a porcine model.

Hoffmann BA, Koops A, Rostock T, Müllerleile K, Steven D, Karst R, Steinke MU, Drewitz I, Lund G, Koops S, Adam G, Willems S - Eur. Heart J. (2009)

(A) Pre- and (B) post-ablational T2-weighted turbo spin echo sequence showing focal hyperintensity (arrows) in the CTI region (RV, right ventricle; LA, left atrium; LV, left ventricle; ICV, inferior caval vein).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2821629&req=5

EHP460F4: (A) Pre- and (B) post-ablational T2-weighted turbo spin echo sequence showing focal hyperintensity (arrows) in the CTI region (RV, right ventricle; LA, left atrium; LV, left ventricle; ICV, inferior caval vein).
Mentions: The ablation procedure duration within the MRI was 154.8 ± 24.2 min. There was a significant difference between the first and the last 10 ablation procedures (174.0 ± 17.6 vs. 135.7 ± 10.7 min, P < 0.001). The ablation catheter was safely visualized throughout the steering manoeuvre in the interventional procedure, yielding hyperintensity at its distal portion owing to the integrated visualization coil (Figure 3A–C). CTI and adjacent cardiac structures were reliably identified by MRI in all cases. The catheter was successfully placed in the inferior region of the tricuspid valve annulus in all animals. Continuous real-time imaging during each 60 s period of RF ablation allowed constant monitoring of the actual ablation electrode position. An anatomically oriented lesion line (T2-weighted TSE sequence) was achieved after a mean number of 6.3 ± 3 RF pulses (energy: 1807 ± 1016.4 Ws/RF pulse, temperature: 55.9 ± 5.9°C, impedance: 106.9 ± 13.3 Ohm). The TSE sequences for the depiction of focal oedema at the target regions did show a relative swelling and focal hyperintensity; however, not every single focal ablation site could be visualized in detail (Figure 4A and B).

Bottom Line: Catheter position and movement during manipulation were continuously visualized during the entire intervention.Two porcine prematurely died due to VT/VF.In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology/Electrophysiology, University Hospital Eppendorf, University Heart Center, Martinistr 52, D-20246 Hamburg, Germany. b.hoffmann@uke.de

ABSTRACT

Aims: We investigated the feasibility of real-time magnetic resonance imaging (RTMRI) guided ablation of the cavotricuspid isthmus (CTI) by using a MRI-compatible ablation catheter.

Methods and results: Cavotricuspid isthmus ablation was performed in an interventional RTMRI suite by using a novel 7 French, steerable, non-ferromagnetic ablation catheter in a porcine in vivo model (n = 20). The catheter was introduced and navigated by RTMRI visualization only. Catheter position and movement during manipulation were continuously visualized during the entire intervention. Two porcine prematurely died due to VT/VF. Anatomical completion of the CTI ablation line could be achieved after a mean of 6.3+/-3 RF pulses (RF energy: 1807+/-1016.4 Ws/RF pulse, temperature: 55.9+/-5.9 degrees C) in n = 18 animals. In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab.

Conclusion: Completely non-fluoroscopic ablation guided by RTMRI using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology.

Show MeSH