Feasibility of Real-Time Magnetic Resonance Imaging for Catheter Guidance in Electrophysiology Studies

Abstract

Background-Compared with fluoroscopy, the current imaging standard of care for guidance of electrophysiology procedures, magnetic resonance imaging (MRI) provides improved soft-tissue resolution and eliminates radiation exposure. However, because of inherent magnetic forces and electromagnetic interference, the MRI environment poses challenges for electrophysiology procedures. In this study, we sought to test the feasibility of performing electrophysiology studies with real-time MRI guidance. Methods and Results-An MRI-compatible electrophysiology system was developed. Catheters were targeted to the right atrium, His bundle, and right ventricle of 10 mongrel dogs (23 to 32 kg) via a 1.5-T MRI system using rapidly acquired fast gradient-echo images (Ϸ5 frames per second). Catheters were successfully positioned at the right atrial, His bundle, and right ventricular target sites of all animals. Comprehensive electrophysiology studies with recording of intracardiac electrograms and atrial and ventricular pacing were performed. Postprocedural pathological evaluation revealed no evidence of thermal injury to the myocardium. After proof of safety in animal studies, limited real-time MRI-guided catheter mapping studies were performed in 2 patients. Adequate target catheter localization was confirmed via recording of intracardiac electrograms in both patients. Conclusions-To the best of our knowledge, this is the first study to report the feasibility of real-time MRI-guided electrophysiology procedures. This technique may eliminate patient and staff radiation exposure and improve real-time soft tissue resolution for procedural guidance.

Myocardial Fibrosis and the Risk of Recurrence in Atrial Fibrillation

“…Initial experiences suggest that the method is feasible and safe. 16,17 Radiation exposure has been significantly reduced with the new electroanatomic mapping equipment (NAVX, Carto). However, the use of interventional MRI would fully eliminate exposure to radiation.…”

MRI-based communication for untethered intelligent medical microrobots

“…This phenomenon may lead to serious health effects on each person who attends the procedure if there is overexposure [122]. The idea of using an upgraded Magnetic Resonance Imaging (MRI) system to facilitate the steering of a catheter has been proposed and investigated in many studies [122][123][124][125] Using a MRI system not only excludes the ionizing radiation exposure but also enhances the soft tissue contrast in the images [123]. Moreover, fluoroscopy can only describe the lumen of the vessels while MRI can visualize the morphology of the soft tissue surrounding the blood vessels [121,124] Different research propose the idea of placing wound coils at the distal end of a catheter to guide the catheter during intravascular procedures using MRI.…”

Catheter Ablation of Atrial Fibrillation – Techniques and Technology

“…Substantial progress has been made to incorporate this technique into clinical practice. 55 Recently, a cryoablation balloon system was approved for clinical use in the treatment of AF in the United States, although it has been available in Europe for many years. This system achieves PVI by freezing atrial tissue that comes into contact with a balloon that is cooled to -80°C.…”

“…There is little data to suggest a role for these systems, although clinical trials are underway in order to do so. 55,56 Finally, a hybrid thoracoscopic and transvenous catheter approach has been investigated in a recent prospective single centre study. The authors report a single procedure success rate of 86 % for the 26 patients who enrolled.…”