B-PO04-108 FIRST IN CLINICAL ROUTINE ISTHMUS-DEPENDENT ATRIAL FLUTTER ABLATION ENTIRELY PERFORMED IN THE INTERVENTIONAL MRI SUITE USING ACTIVE CATHETER IMAGING

Abstract

Recently, magnetic resonance imaging (MRI) has been established as a radiation-free alternative to fluoroscopy to image anatomy and structural alterations causative for arrhythmogenesis during cavotricuspid isthmus (CTI) dependent atrial flutter (AFl) ablation procedures. Describe the first real-world experience of CTI ablations performed completely in the interventional cardiac magnetic resonance (iCMR) suite using active catheter imaging. Fifteen patients (73% male, median age 70 yrs (IQR 67-82) underwent ablations in the iCMR suite. Procedures were performed in a 1.5T MRI with MR-conditional ablation catheters. Catheter guidance was performed using active catheter imaging leveraging MR receive coils within the catheter tip [Figure]. Ablation success, complications, and time for procedure were collected. All 15 patients achieved acute procedure success without complication. Median procedure time was 43min (IQR 33-58) with an RF delivery time of 18 min (interquartile range (IQR) 12-26). Post-procedure lesion visualization scanning was 32 min (IQR 10-42). In 5 patients left ventricular ejection fraction improved from 28±7 % to 47±6% after ablation. Of the13 patients that made it to 6 month follow up (1 lost to follow up, 1 death at 6 months), none of the patients had AFl recurrence. CTI-dependent AFl ablation using active catheter imaging can successfully be performed entirely in the iCMR suite. The MR environment allows anatomic visualization of the CTI, intra-procedural lesion visualization, and exclusion of a pericardial effusion.