Real-time imaging in electrophysiology: from intra-cardiac echo to real-time magnetic resonance imaging

Abstract

Interventional electrophysiology using catheter ablation is a rapidly growing field that has allowed for the cure of arrhythmias originating from every cardiac chamber as well as the great vessels. The keys to the success of the ablation procedure are targeting critical areas required to initiate and sustain the arrhythmias as well as insuring the delivery of effective ablation lesions. Understanding the intricate relationship between the anatomical structures and their functional relationship to the arrhythmia, or the ‘electro-anatomical substrate’, represents the greatest limitation to the success of the ablation procedure. For atrial fibrillation, the electro-anatomical substrate largely consists of the posterior wall of the left atrium which includes the pulmonary vein antra,1 and most operators aim for at least electrical isolation of the pulmonary veins and consider this to be an acceptable endpoint for the procedure.2,3 Several technological tools are currently available to guide catheter navigation with more advances coming down the pipeline. When used in combination, these have made ablation procedures safer, shorter, and more successful.4 These include X-ray fluoroscopy, electro-anatomical mapping systems with … *Corresponding author. Tel: +1 801 581 2572, Fax: +1 435 658 1527. Email: nassir.marrouche{at}hsc.utah.edu