MR Imaging–guided Electrophysiological Ablation Studies in Humans with Passive Catheter Tracking: Initial Results

Piorkowski, Christopher; Eitel, Charlotte; Gaspar, Thomas; Lehmkuhl, Lukas; Lücke, Christian; Hoffmann, Janine; Hildebrand, Lysann; Wedan, Steve; Lloyd, Thomas; Sunnarborg, Daniel; Schnackenburg, Bernhard; Hindricks, Gerhard; Sommer, Philipp; Gutberlet, Matthias

doi:10.1148/radiol.13122671

Cited by 52 publications

(50 citation statements)

References 26 publications

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“…Due to the 2 D nature of X-ray fluoroscopy, various 3 D mapping systems using previously acquired 3 D datasets from CT or MRI have been developed. However, these systems still have problems primarily with regard to the registration and fusion of datasets and therefore continue to require additional fluoroscopy [67].…”

Section: Mr-guided Cardiac Ablationmentioning

confidence: 99%

“…5). Grothoff et al [67] successfully performed this procedure in patients on a 1.5 T MRI unit. A real-time SSFP sequence was used for imaging.…”

Section: Mr-guided Cardiac Ablationmentioning

confidence: 99%

“…A Intervention in a 1.5 T scanner with placed, MR conditional catheters (IMRICOR) and head sets for communication. Sucessful ablation with delineation of the edema in a STIR image (B, arrow) and the scar (C, arrow) on late enhancement IR_GRE and in RAO projection [67].…”

Section: Navigationmentioning

confidence: 99%

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White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function.Method The current status of interventional MRI for the clinical routine was analyzed.Results The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion IntroductionMRI has an intrinsically high soft-tissue contrast and can be used to measure physiological parameters, such as blood flow (flow rate and flow volume), diffusion, temperature, and movement. Since its introduction into the clinical routine in the 1980 s, it has also been used for guiding and monitoring interventions. However, in contrast to CT and ultrasound, the use of MRI for guiding interventions requires significant technical effort. Due to the disruptive effect of the strong main magnetic field and the alternating electromagnetic fields, the monitoring of patients during an intervention by measuring ECG signals, oxygen saturation, or blood pressure requires special equipment. These monitoring systems must not interfere with the MRI scan and must be MR-safe (according to DIN EN 62 570:2010 -05). The list of requirements regarding monitoring equipment provides an indication of the development effort, with suitable monitoring equipment representing only one of the components necessary for MR-guided interventions.In addition to MRI safety, all catheters and instruments must be adapted to this modality. To ensure MRI safety, metal must be largely avoided since, depending on the length and orientation to the main magnetic field, it can heat up and consequently even result in burns. Achieving rigidity and torsion stability of catheters or guide wires without the use of metal for reinforcement represents a technical challenge. In the case of needles, breaking resistance is one of the more difficult properties to achieve for MR-safe designs. Moreover, instruments must be able to be effectively visualized without adjacent structures being superimposed by artifacts. The tip must be able to be identified and definitively differentiated from the shaft since MRI as a cross-sectional imaging method typically uses individual slices even for guiding interventions and does not use projections as in fluoroscopy...

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Section: Mr-guided Cardiac Ablationmentioning

confidence: 99%

“…5). Grothoff et al [67] successfully performed this procedure in patients on a 1.5 T MRI unit. A real-time SSFP sequence was used for imaging.…”

Section: Mr-guided Cardiac Ablationmentioning

confidence: 99%

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White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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“…These companies are in the process of developing a range of MRI-compatible devices with regulatory approval. 24,25,31 Electric Anatomic Mapping An important component of the conventional electrophysiology studies are the EAM systems that allow for catheter navigation inside realistic anatomic heart models. Recent studies have proposed modifications to create MRI-compatible EAM systems.…”

Section: Instrumentation Electrophysiology Studymentioning

confidence: 99%

Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

Bhagirath

Graaf

Karim

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Количественные показатели оценки состояния предсердий при контрастированной МРТ сердца у пациентов с синусовым ритмом Объем включения парамагнетика в наибольшем очаге поглощения контраста, см дов при проведении внутрисердечных электрофизио-логических исследований и аблации источников аритмий [10]. Однако в кардиологической клинике не менее важна задача своевременной ранней оценки риска развития пароксизмальных наджелудочковых тахи-аритмий на возможно ранних стадиях их проявления, в частности у пациентов, перенесших острый инфаркт миокарда.…”

Section: таблицаunclassified

Contrast Magnetic Resonance Investigation in Patients After Myocardial Infarction and Tachiarrhythmias

Usov¹,

Бабокин²,

Мочула³

et al. 2014

Russ J Cardiol

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Представлены результаты использования магнитно-резонансной томографии сердца с парамагнитным контрастированием для визуального выявления оча-гов повреждения миокарда, провоцирующих развитие предсердных нарушений ритма у пациентов с перенесенным обширным инфарктом левого желудочка. Показано, что объем левого предсердия более 75 см 3 и накопление контраста-парамагнетика в миокарде предсердий с индексом усиления в Т1-взв. спин-эхо режиме более 1,27 являются прогностическими факторами в отношении разви-тия наджелудочковых тахиаритмий, а магнитно-резонансная томография серд ца с контрастированием является важным дополнительным методом исследования у пациентов с предсердными нарушениями ритма сердца. We present the results of MRI study of the heart with paramagnetic contrasting for visualization of the foci of myocardial damage, that lead to atrial tachiarrhythmias in patients with severe infarction of the left ventricle. It is shown that the volume of the left atrium more than 75 cm 3 and accumulation of paramagnetic contrast in atrial myocardium with the enhancement T1-adj. spin-echo regimen index more than 1,27 are prognostic factors for atrial tachiarrhythmias, and MRI of the heart with contrast is an important additional method of patients' investigation with atrial rhythm disorders. Russ

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MR Imaging–guided Electrophysiological Ablation Studies in Humans with Passive Catheter Tracking: Initial Results

Abstract: Real-time MR imaging-guided placement of multiple catheters is feasible in patients, with subsequent performance of stimulation maneuvers and occasional complete isthmus ablation.

Cited by 52 publications

References 26 publications

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

Contrast Magnetic Resonance Investigation in Patients After Myocardial Infarction and Tachiarrhythmias

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