Electrophysiological Cardiovascular Magnetic Resonance (EP-CMR)-Guided Interventional Procedures: Challenges and Opportunities

Cardiovascular magnetic resonance (CMR) imaging excels in providing detailed three-dimensional anatomical information together with excellent soft tissue contrast and has already become a valuable tool for diagnostic evaluation, electrophysiological procedure (EP) planning, and therapeutical stratification of atrial or ventricular rhythm disorders. CMR-based identification of ablation targets may significantly impact existing concepts of interventional electrophysiology. In order to exploit the inherent advantages of CMR imaging to the fullest, CMR-guided ablation procedures (EP-CMR) are justly considered the ultimate goal.

Electrophysiological cardiovascular magnetic resonance (EP-CMR) interventional procedures have more recently been introduced to the CMR armamentarium: in a single-center series of 30 patients, an EP-CMR guided ablation success of 93% has been reported, which is comparable to conventional ablation outcomes for typical atrial flutter and procedure and ablation time were also reported to be comparable. However, moving on from already established workflows for the ablation of typical atrial flutter in the interventional CMR environment to treatment of more complex ventricular arrhythmias calls for technical advances regarding development of catheters, sheaths and CMR-compatible defibrillator equipment.

CMR imaging has already become an important diagnostic tool in the standard clinical assessment of cardiac arrhythmias. Previous studies have demonstrated the feasibility and safety of performing electrophysiological interventional procedures within the CMR environment and fully CMR-guided ablation of typical atrial flutter can be implemented as a routine procedure in experienced centers. Building upon established workflows, the market release of new, CMR-compatible interventional devices may finally enable targeting ventricular arrhythmias.