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 suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR 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 CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, 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 CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.
Highlights
Radiofrequency (RF) catheter ablation has advanced over the last 25 years from an experimental procedure to the first line treatment for a number of cardiac arrhythmias including atrio-ventricular reentrant tachycardia, accessory pathway associated tachycardias, and typical atrial flutter [1]. These procedures are typically guided by positioning electrode catheters using x-ray fluoroscopy and using these catheters to observe the propagation of electrical activity through the heart
While the feasibility of x-ray fluoroscopy guidance has been demonstrated for these complex arrhythmias, precise targeting of ablation lesions is limited by fluoroscopy's inherently poor ability to visu
Increasing knowledge of the anatomic basis for cardiac arrhythmias has extended the role of catheter ablation to curing even complex rhythms such as atrial fibrillation and scar based ventricular tachycardia
Summary
Radiofrequency (RF) catheter ablation has advanced over the last 25 years from an experimental procedure to the first line treatment for a number of cardiac arrhythmias including atrio-ventricular reentrant tachycardia, accessory pathway associated tachycardias, and typical atrial flutter [1]. For structures where efficient power transfer is required, such as pacing or ablation electrodes, high frequency RF chokes can allow passage of signal lower than a few MHz while blocking unwanted MR transmit frequency currents [95,96] A promising heating suppression technique for position tracking and intravascular imaging coils that need to pass differential mode signals at the same frequencies as unwanted common mode induced currents is to place thin transmission line transformers in the signal carrying cables [77,97,98] Other strategies such as detuning and decoupling of circuits prone to heating [78,99], fiberoptic transmission of signals [100], and use of inductively coupled resonators for wireless device tracking [101] are considerations for new device design [25,90]. The impact of device related artifacts on cardiac image interpretation needs to be more carefully studied
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