A Magnetic Resonance Imaging–Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore

Schmidt, Ehud J.; Watkins, Ronald D.; Zviman, Menekhem; Wang, Wei; Halperin, Henry A.

doi:10.1161/circimaging.116.005091

Cited by 20 publications

(21 citation statements)

References 35 publications

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“…A further consideration is the relatively high risk of arrhythmias in this patient group. There is currently no commercial MR-conditional defibrillator solution that has been released, although there is ongoing work to develop the capabilities 130 . Therefore, robust protocols and training must be in place for evacuation of the patient to a safe zone for medical resuscitation if required.…”

Section: Anaesthesia and Monitoringmentioning

confidence: 99%

MR-guided Cardiac Interventions

Pushparajah

Chubb

Razavi

2018

Topics in Magnetic Resonance Imaging

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Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.

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Section: Anaesthesia and Monitoringmentioning

confidence: 99%

MR-guided Cardiac Interventions

Pushparajah

Chubb

Razavi

2018

Topics in Magnetic Resonance Imaging

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“…In this context, a recent report has described a prototype MR-conditional defibrillation system to successfully defibrillate swine inside and outside a scanner bore. 78 Electrical cardioversion during a procedure will inevitably result in patient movement and subsequent changes in the position of the heart relative to reconstructed anatomical shells. As is the case with EAM systems, repeated real-time MR confirmation scans may be necessary to update anatomical shells and maintain accurate registration.…”

Section: Real-time Magnetic Resonance-guided Electrophysiology and Abmentioning

confidence: 99%

Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation

et al. 2018

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Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.

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“…10 Mazal et al describes the evacuation roles and reports evacuation times of less than 1 minute. 39 In-bore defibrillators 99 and temporary pacemakers are also under development to address these contingencies.…”

Section: Integration With Clinical Workflowmentioning

confidence: 99%

Real‐time MRI guidance of cardiac interventions

Campbell-Washburn

Tavallaei

Pop

et al. 2017

Magnetic Resonance Imaging

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Cardiac MR is appealing to guide complex cardiac procedures because it is ionizing radiation free and offers flexible soft tissue contrast. Interventional cardiac MR promises to improve existing procedures and enable new ones for complex arrhythmias, as well as congenital and structural heart disease. Guiding invasive procedures demands faster image acquisition, reconstruction and analysis, as well as intuitive intra-procedural display of imaging data. Standard cardiac MR techniques such as 3D anatomical imaging, cardiac function and flow, parameter mapping and late-gadolinium enhancement can be used to gather valuable clinical data at various procedural stages. Rapid intraprocedural image analysis can extract and highlight critical information about interventional targets and outcomes. In some cases, real-time interactive imaging is used to provide a continuous stream of images displayed to interventionalists for dynamic device navigation. Alternatively, devices are navigated relative to a roadmap of major cardiac structures generated through fast segmentation and registration. Interventional devices can be visualized and tracked throughout a procedure with specialized imaging methods. In a clinical setting, advanced imaging must be integrated with other clinical tools and patient data. In order to perform these complex procedures, interventional cardiac MR relies on customized equipment, such as interactive imaging environments, in-room image display, audio communication, hemodynamic monitoring and recording systems, and electroanatomical mapping and ablation systems. Operating in this sophisticated environment requires coordination and planning. This review will provide an overview of the imaging technology used in MRI-guided cardiac interventions. Specifically, this review will outline clinical targets, standard image acquisition and analysis tools, and the integration of these tools into clinical workflow.

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A Magnetic Resonance Imaging–Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore

Cited by 20 publications

References 35 publications

MR-guided Cardiac Interventions

MR-guided Cardiac Interventions

Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation

Real‐time MRI guidance of cardiac interventions

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