Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation

Bauer, Bastian Klemens; Meier, Claudia; Bietenbeck, Michael; Lange, Philipp; Eckardt, Lars; Yılmaz, Ali

doi:10.1016/j.jacep.2021.11.017

Cited by 5 publications

(7 citation statements)

References 56 publications

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“…Moreover, using gradient-echo and balanced steady-state free precession (bSSFP) CMR sequences, only frame rates of 2–8/s can be achieved, limiting the temporal resolution of real-time CMR. 4 Finally, cardiac implantable electronic devices may cause off-resonance artefacts that impair image assessment, particularly in anterior and lateral left ventricular wall segments. In general, using CMR guidance introduces a new level of complexity into interventional electrophysiology.…”

Section: Cmr-guided Ablation Of Atrial Fluttermentioning

confidence: 99%

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Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience

Zan

Calò

Borrelli

et al. 2023

European Heart Journal Supplements

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Radiofrequency (RF) catheter ablation has become a widely used therapeutic approach. However, long-term results in terms of arrhythmia recurrence are still suboptimal. Cardiac magnetic resonance (CMR) could offer a valuable tool to overcome this limitation, with the possibility of targeting the arrhythmic substrate and evaluating the location, depth, and possible gaps of RF lesions. Moreover, real-time CMR-guided procedures offer a radiation-free approach with an evaluation of anatomical structures, substrates, RF lesions, and possible complications during a single procedure. The first steps in the field have been made with cavotricuspid isthmus ablation, showing similar procedural duration and success rate to standard fluoroscopy-guided procedures, while allowing visualization of anatomic structures and RF lesions. These promising results open the path for further studies in the context of more complex arrhythmias, like atrial fibrillation and ventricular tachycardias. Of note, setting up an interventional CMR (iCMR) centre requires safety and technical standards, mostly related to the need for CMR-compatible equipment and medical staff’s educational training. For the cardiac imagers, it is fundamental to provide correct CMR sequences for catheter tracking and guide RF delivery. At the same time, the electrophysiologist needs a rapid interpretation of CMR images during the procedures. The aim of this paper is first to review the logistic and technical aspects of setting up an iCMR suite. Then, we will describe the experience in iCMR-guided flutter ablations of two European centres, Policlinico Casilino in Rome, Italy, and Haga Teaching Hospital in The Hague, the Netherlands.

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Section: Cmr-guided Ablation Of Atrial Fluttermentioning

confidence: 99%

“…In particular, ablation of the cavotricuspid isthmus (CTI) by iCMR real-time guidance is increasingly performed in different centres with performance and outcome measures similar to conventional, fluoroscopy-guided flutter ablation. 4 …”

Section: Introductionmentioning

confidence: 99%

Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience

Zan

Calò

Borrelli

et al. 2023

European Heart Journal Supplements

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“…In addition it can serve as an important safety tool for asses pericardial effusion and assessing ablation lesion depth ( 44 ). Real-time CMR guided ablation procedures have been described in a few case series ( 45 ). The advantages of this system is ability to image and assess the entire myocardium and ablation lesions in real time.…”

Section: Role Of Intra-procedural Imagingmentioning

confidence: 99%

Catheter ablation of ventricular tachycardia: strategies to improve outcomes

Subramanian,

Atreya,

Saggu

et al. 2023

Front. Cardiovasc. Med.

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Catheter ablation of ventricular arrhythmias has evolved considerably since it was first described more than 3 decades ago. Advancements in understanding the underlying substrate, utilizing pre-procedural imaging, and evolving ablation techniques have improved the outcomes of catheter ablation. Ensuring safety and efficacy during catheter ablation requires adequate planning, including analysis of the 12 lead ECG and appropriate pre-procedural imaging. Defining the underlying arrhythmogenic substrate and disease eitology allow for the developed of tailored ablation strategies, especially for patients with non-ischemic cardiomyopathies. During ablation, the type of anesthesia can affect VT induction, the quality of the electro-anatomic map, and the stability of the catheter during ablation. For high risk patients, appropriate selection of hemodynamic support can increase the success of VT ablation. For patients in whom VT is hemodynamically unstable or difficult to induce, substrate modification strategies can aid in safe and successful ablation. Recently, there has been an several advancements in substrate mapping strategies that can be used to identify and differentiate local late potentials. The incorporation of high-definition mapping and contact-sense technologies have both had incremental benefits on the success of ablation procedures. It is crucial to harness newer technology and ablation strategies with the highest level of peri-procedural safety to achieve optimal long-term outcomes in patients undergoing VT ablation.

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“…[1][2][3][4][5] The combination of measurable parameters and inherent co-registration holds the promise for improved outcomes and reduced recurrences. 6 A typical workflow 3 for the MR intervention used here is sketched in Figure S1. Briefly, a continuous update of the device position assessed via catheter tracking 7,8 is projected onto a previously acquired, static MR "roadmap."…”

Section: F I G U R Ementioning

confidence: 99%

“…Magnetic resonance imaging offers excellent 3D soft tissue and lesion visualization, arrhythmic substrate identification, and allows conducting invasive cardiovascular procedures, including localization and tracking of interventional devices and postprocedural follow‐up, within a single‐session examination using a single imaging modality 1–5 . The combination of measurable parameters and inherent co‐registration holds the promise for improved outcomes and reduced recurrences 6 …”

Section: Introductionmentioning

confidence: 99%

Silent active device tracking for MR‐guided interventional procedures

Stehning

Krueger

Weiß

et al. 2022

Magnetic Resonance in Med

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Purpose To evaluate a silent MR active catheter tracking sequence that allows conducting catheter interventions with low acoustic noise levels. Methods To reduce the acoustic noise associated with MR catheter tracking, we implemented a technique previously used in conventional MRI. The gradient waveforms are modified to reduce the sound pressure level (SPL) and avoid acoustic resonances of the MRI system. The efficacy of the noise reduction was assessed by software‐predicted SPL and verified by measurements. Furthermore, the quality of the catheter tracking signal was assessed in a phantom experiment and during interventional cardiovascular MRI sessions targeted at isthmus‐related flutter ablation. Results The maximum measured SPL in the scanner room was 104 dB(A) for real‐time imaging, and 88 dB(A) and 69 dB(A) for conventional and silent tracking, respectively. The SPL measured at different positions in the MR suite using silent tracking were 65–69 dB(A), and thus within the range of a normal conversation. Equivalent signal quality and tracking accuracy were obtained using the silent variant of the catheter tracking sequence. Conclusion Our results indicate that silent MR catheter tracking capabilities are identical to conventional catheter tracking. The achieved acoustic noise reduction comes at no penalty in terms of tracking quality or temporal resolution, improves comfort and safety, and can overcome the need for MR‐compatible communication equipment and background noise suppression during the actual interventional procedure.

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Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation

Cited by 5 publications

References 56 publications

Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience

Cardiac magnetic resonance-guided cardiac ablation: a case series of an early experience

Catheter ablation of ventricular tachycardia: strategies to improve outcomes

Silent active device tracking for MR‐guided interventional procedures

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