MRI-Guided Electrophysiology Intervention

Abstract

Catheter ablation is a first-line treatment for many cardiac arrhythmias and is generally performed under X-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with sub-optimal success rates and prolonged radiation exposure. Pre-procedure 3-D magnetic resonance imaging (MRI) has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of MRI compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure MRI is now being applied to assess ablation lesion location and permanence with the goal of identifying factors leading to procedure success and failure. In the future, intra-procedure real-time MRI, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade MRI-compatible electrophysiology devices is required to transition intra-procedure MRI from preclinical studies to more routine use in patients.

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

“…Although these systems are still under development and are not available with routine clinical use at this time, this is an area of considerable interest that could emerge as an important ablation monitoring and guidance strategy in the future. 792 , 793 , 794 , 795 …”

Model-Free Position Control for Cardiac Ablation Catheter Steering Using Electromagnetic Position Tracking and Tension Feedback

“…However, the complex and delicate nature of those procedures make it difficult to steer the catheter manually, even for an experienced operator, which also causes prolonged operation times and complication by ablating ectopic location. Hence, extensive training is required for the clinician to perform such procedures, requiring development of task-specific manual dexterity and co-ordination (Halperin and Kolandaivelu, 2010). In addition, the procedures are mostly guided using X-ray images, thus the often long procedure times increase the radiation burden for both the clinician and patient.…”