Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

Bhagirath, Pranav; Graaf, Maurits van der; Karim, Rashed; Rhode, Kawal; Piorkowski, Christopher; Razavi, Reza; Schwitter, Juerg; Götte, Marco J.W.

doi:10.1161/circep.114.002371

Cited by 22 publications

(14 citation statements)

References 54 publications

(55 reference statements)

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“…A potential application of MRI is to guide the ablation procedure in real time, which has the promise to provide acute feedback needed for successful lesion delivery . To be effective, the acute MRI methods must also predict reliably the size of the resulting chronic lesions .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] A potential application of MRI is to guide the ablation procedure in real time, which has the promise to provide acute feedback needed for successful lesion delivery. 9,10 To be effective, the acute MRI methods must also predict reliably the size of the resulting chronic lesions. 11 LGE-MRI can partially provide such information, but due to severe restrictions on contrast administration, this contrast-enhanced imaging technique has been used only at the end of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Acute noncontrast T1‐weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Kholmovski

Silvernagel

Angel

et al. 2018

Cardiovasc electrophysiol

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Background: MRI has been used to visualize radiofrequency (RF) ablation lesions but the relationship between volumes that enhance in acute MRI and the chronic lesion size is unknown. Objectives: The main goal was to use non-contrast (native) T1 weighted (T1w) MRI and late gadolinium enhancement (LGE) MRI to visualize lesions acutely and chronically and correlate the acute area of enhancement with chronic lesion size in histology. Methods: In a canine (n=9) model RF ablation lesions were created in both ventricles. Native T1w MRI and LGE-MRI were acquired acutely after the ablation procedure. After 8 weeks, another set of RF ablations was performed and the MRI study was repeated. Volume and depth of enhancement in native T1w MRI and LGEMRI acquired after the initial ablation procedure were correlated with chronic lesion volume and depth in histology. Results: 33 lesions were analyzed. Native T1w MRI visualized the acute lesions but not the chronic lesions. LGE-MRI showed both acute and chronic lesions. Acute native T1w MRI volume (average of 102.1±48.5mm3) and depth (4.9±1.2 mm) correlated well with chronic histological volume (105.9±51.8mm3) and depth (4.8±1.3mm) with R2 of 0.881, p<0.001 and 0.874, p<0.001 respectively. Acute LGE MRI had significantly higher volume of enhancement of 499.7±214.4mm3 (p< 0.001) and depth of 7.5±1.8mm (p<0.001) compared to chronic histological lesion volume and depth. Conclusion: Native T1w MRI acquired acutely after RF ablation is a good predictor of chronic lesion size. Acute LGE-MRI significantly overestimates chronic lesion size.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute noncontrast T1‐weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Kholmovski

Silvernagel

Angel

et al. 2018

Cardiovasc electrophysiol

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“…Real‐time MRI techniques provide an immediate and direct means of measuring ablation‐related tissue changes in addition to improved visualization of the tissue, as shown by numerous prior studies . Despite this appeal of using MRI in real time, the techniques are still being developed and are not ready for clinical use . As a result, one has to rely on indirect measurements and test for electrical isolation using functional assays.…”

Section: Discussionmentioning

confidence: 99%

Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size

Thomas

Silvernagel

Angel

et al. 2018

Cardiovasc electrophysiol

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“…Teams should prepare for emergency evacuation to a designated space for resuscitation with MRI-incompatible equipment. 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%

“…Multiple review papers have summarized clinical translation of interventional MR, 10, 11 electrophysiology applications, 10 valve and stent applications, 12 pediatric applications, 13 and technical requirements. 14, 15 …”

Section: Introductionmentioning

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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Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology

Cited by 22 publications

References 54 publications

Acute noncontrast T1‐weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Acute noncontrast T1‐weighted magnetic resonance imaging predicts chronic radiofrequency ablation lesions

Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size

Real‐time MRI guidance of cardiac interventions

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