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Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 2/2019

Open Access 01-02-2019 | Magnetic Resonance Imaging | Cardiac Magnetic Resonance (E Nagel and V Puntmann, Section Editors)

Advances in Real-Time MRI–Guided Electrophysiology

Authors: Rahul K. Mukherjee, Henry Chubb, Sébastien Roujol, Reza Razavi, Mark D. O’Neill

Published in: Current Cardiovascular Imaging Reports | Issue 2/2019

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Abstract

Purpose of Review

Theoretical benefits of real-time MRI guidance over conventional electrophysiology include contemporaneous 3D substrate assessment and accurate intra-procedural guidance and evaluation of ablation lesions. We review the unique challenges inherent to MRI-guided electrophysiology and how to translate the potential benefits in the treatment of cardiac arrhythmias.

Recent Findings

Over the last 5 years, there has been substantial progress, initially in animal models and more recently in clinical studies, to establish methods and develop workflows within the MR environment that resemble those of conventional electrophysiology laboratories. Real-time MRI-guided systems have been used to perform electroanatomic mapping and ablation in patients with atrial flutter, and there is interest in developing the technology to tackle more complex arrhythmias including atrial fibrillation and ventricular tachycardia.

Summary

Mainstream adoption of real-time MRI-guided electrophysiology will require demonstration of clinical benefit and will be aided by increased availability of devices suitable for use in the MRI environment.
Literature
1.
Knackstedt C, Schauerte P, Kirchhof P. Electroanatomic mapping systems in arrhythmias. Europace. 2008;10 Suppl 3:iii28–34.PubMed
2.
Muser D, Santangeli P, Castro SA, Pathak RK, Liang JJ, Hayashi T, et al. Long-term outcome after catheter ablation of ventricular tachycardia in patients with non-ischaemic cardiomyopathy. Circ Arrhythm Electrophysiol. 2016;9:e004328.PubMed
3.
Scherr D, Khairy P, Miyazaki S, Aurillac-Lavignolle V, Pascale P, Wilton SB, et al. Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint. Circ Arrhythm Electrophysiol. 2015;8:18–24.CrossRef
4.
Andreu D, Ortiz-Perez JT, Fernandez-Armenta J, Guiu E, Acosta J, Prat-Gonzalez S, et al. 3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation. Europace. 2015;17:938–45.CrossRef
5.
Josephson ME, Anter E. Substrate mapping for ventricular tachycardia: assumptions and misconceptions. J Am Coll Cardiol. 2015;5:341–52.
6.
Anter E, Tschabrunn CM, Buxton AE, Josephson ME. High-resolution mapping of postinfarction re-entrant ventricular tachycardia: electrophysiological characterisation of the circuit. Circulation. 2016;134:314–27.CrossRef
7.
Wright M, Harks E, Deladi S, Fokkenrood S, Brink R, Belt H, et al. Characteristics of radiofrequency catheter ablation lesion formation in real time in vivo using near-field ultrasound imaging. JACC Clin Electrophysiol. 2018;4:1062–72.CrossRef
8.
Chubb H, Williams SE, Whitaker J, Harrison JL, Razavi R, O’Neill M. Cardiac electrophysiology under MRI guidance: an emerging technology. Arrhythmia Electrophysiol Rev. 2017;6:85–93.CrossRef
9.
• Andreu D, Penela D, Acosta J, Fernandez-Armenta J, Perea RJ, Soto-Iglesias D, et al. Cardiac magnetic resonance-aided scar dechanneling: influence on acute and long-term outcomes. Heart Rhythm. 2017;14:1121–8 Non-randomised study to demonstrate an improvement in clinical outcome through the use of cardiac MRI to guide VT ablation.CrossRef
10.
Zghaib T, Ipek EG, Hansford R, Ashikaga H, Berger RD, Marine JE, et al. Standard ablation versus magnetic resonance imaging-guided ablation in the treatment of ventricular tachycardia. Circ Arrhythm Electrophysiol. 2018;11:e005973.PubMedPubMedCentral
11.
Roujol S, Basha TA, Tan A, Khanna V, Chan RH, Moghari MH, et al. Improved multimodality data fusion of late gadolinium enhancement MRI to left ventricular voltage maps in ventricular tachycardia ablation. IEEE Trans Biomed Eng. 2013;60:1308–17.CrossRef
12.
Mukherjee RK, Whitaker J, Williams SE, Razavi R, O’Neill MD. Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation. Europace. 2018;20:1721–32.CrossRef
13.
Roujol S, Anter E, Josephson ME, Nezafat R. Characterisation of respiratory and cardiac motion from electro-anatomical mapping data for improved fusion of MRI to left ventricular electrograms. PLoS One. 2013;8:e78852.CrossRef
14.
Shah D, Haissaguerre M, Takahashi A, Jais P, Hocini M, Clementy J. Differential pacing for distinguishing block from persistent conduction through an ablation line. Circulation. 2000;102:1517–22.CrossRef
15.
Oster J, Pietquin O, Kraemer M, Felblinger J. Nonlinear Bayesian filtering for deionising of electrograms acquired in a magnetic resonance environment. IEEE Trans Biomed Eng. 2010;57:1628–38.CrossRef
16.
Tse ZT, Dumoulin CL, Clifford GD, Schweitzer J, Qin L, Oster J, et al. A 1.5T MRI-conditional 12-lead electrogram for MRI and intra-MR intervention. Magn Reson Med. 2014;71:1336–47.CrossRef
17.
Felblinger J, Slotboom J, Kreis R, Jung B, Boesch C. Restoration of electrophysiological signals distorted by inductive effects of magnetic field gradients during MR sequences. Magn Reson Med. 1999;41:715–21.CrossRef
18.
Nazarian S, Kolandaivelu A, Zviman MM, Meininger GR, Kato R, Susil RC, et al. Feasibility of real-time magnetic resonance imaging for catheter guidance in electrophysiology studies. Circulation. 2008;118:223–9.CrossRef
19.
•• Hilbert S, Sommer P, Gutberlet M, Gaspar T, Foldyna B, Piorkowski C, et al. Real-time magnetic resonance guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualisation in man: initial results from a consecutive patient series. Europace. 2016;18:572–7 Real-time MRI-guided catheter ablation of atrial flutter in patients—acute outcomes presented.CrossRef
20.
•• Chubb H, Harrison JL, Weiss S, Krueger S, Koken P, Bloch LO, et al. Development, preclinical validation and clinical translation of a cardiac magnetic resonance-electrophysiology system with active catheter tracking for ablation of cardiac arrhythmia. JACC Clin Electrophysiol. 2017;3:89–103 Real-time MRI-guided catheter ablation of atrial flutter in patients—longer-term outcomes presented.CrossRef
21.
• Elbes D, Magat J, Govari A, Ephrath Y, Vieillot D, Beeckler C, et al. Magnetic resonance imaging-compatible circular mapping catheter: an in vivo feasibility and safety study. Europace. 2017;19:458–64 Assessment of a new multi-electrode MR-compatible catheter to enable complex arrhythmia mapping and ablation.PubMed
22.
Oduneye SO, Pop M, Shurrab M, Biswas L, Ramanan V, Barry J, et al. Distribution of abnormal potentials in chronic myocardial infarction using a real time magnetic resonance guided electrophysiology system. J Cardiovasc Magn Reson. 2015;17:27.CrossRef
23.
Wu V, Barbash IM, Ratnayaka K, Saikus CE, Sonmez M, Kocaturk O, et al. Adaptive noise cancellation to suppress electrocardiograhy artifacts during real-time interventional MRI. J Magn Reson Imaging. 2011;33:1184–93.CrossRef
24.
Grothoff M, Piorkowski C, Eitel C, Gaspar T, Lehmkuhl L, Lucke C, et al. MR imaging-guided electrophysiological ablation studies in humans with passive catheter tracking: initial results. Radiology. 2014;271:695–702.CrossRef
25.
Ratnayaka K, Faranesh AZ, Hansen MS, Stine AM, Halabi M, Barbash IM, et al. Real-time MRI-guided right heart catheterisation in adults using passive catheters. Eur Heart J. 2013;34:380–9.CrossRef
26.
Nordbeck P, Quick HH, Ladd ME, Ritter O. Real-time magnetic resonance guidance of interventional electrophysiology procedures with passive catheter visualisation and tracking. Heart Rhythm. 2013;10:938–9.CrossRef
27.
Omary RA, Unal O, Koscielski DS, Frayne R, Korosec FR, Mistretta CA, et al. Real-time MR imaging-guided passive catheter tracking with use of gadolinium-filled catheters. J Vasc Interv Radiol. 2000;11:1079–85.CrossRef
28.
Velasco Forte MN, Pushparajah K, Schaeffter T, Valverde Perez I, Rhode K, Ruijsink B, et al. Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterisation using partial saturation (pSAT). J Cardiovasc Magn Reson. 2017;19:60.CrossRef
29.
Campbell-Washburn AE, Tavallaei MA, Pop M, Grant EK, Chubb H, Rhode K, et al. Real-time MRI guidance of cardiac interventions. J Magn Reson Imaging. 2017;46:935–50.CrossRef
30.
Daniels BR, Pratt R, Giaquinto R, Dumoulin C. Optimizing accuracy and precision of micro-coil localization in active-MR tracking. Magn Reson Imaging. 2016;34:289–97.CrossRef
31.
Grothoff M, Gutberlet M, Hindricks G, Fleiter C, Schnackenburg B, Weiss S, et al. Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking—experience with 14 cases. Eur Radiol. 2017;27:1954–62.CrossRef
32.
Mukherjee RK, Roujol S, Chubb H, Harrison J, Williams S, Whitaker J, et al. Epicardial electroanatomical mapping, radiofrequency ablation and lesion imaging in the porcine left ventricle under real-time magnetic resonance imaging guidance—an in vivo feasibility study. Europace. 2018;20(FI2):f254–62. https://​doi.​org/​10.​1093/​europace/​eux341.CrossRefPubMed
33.
Oduneye SO, Biswas L, Ghate S, Ramanan V, Barry J, Laish-FarKash A, et al. The feasibility of endocardial propagation mapping using magnetic resonance guidance in a swine model and comparison with standard electroanatomical mapping. IEEE Trans Med Imaging. 2012;31:977–83.CrossRef
34.
Wang W. Magnetic resonance-guided active catheter tracking. Magn Reson Imaging Clin N Am. 2015;23:579–89.CrossRef
35.
Radau PE, Pintilie S, Flor R, Biswas L, Oduneye SO, Ramanan V, et al. VURTIGO: visualization platform for real-time MRI-guided cardiac electroanatomic mapping. In: Camara O, et al., editors. Lecture notes in computer science 7085. Toronto: STACOM; 2011. p. 244–53.
36.
Arujuna A, Karim R, Zarinabad N, Gill J, Rhode K, Schaeffter T, et al. A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs standard catheter ablation. Europace. 2015;17:1241–50.CrossRef
37.
Knowles BR, Caulfield D, Cooklin M, Rinaldi CA, Gill J, Bostock J, et al. 3D visualisation of acute RF ablation lesions using MRI for the simultaneous determination of the patterns of necrosis and edema. IEEE Trans Biomed Eng. 2010;57:1467–75.CrossRef
38.
Kholmovski EG, Silvernagel J, Angel N, Vijayakumar S, Thomas S, Dosdall D, et al. Acute non-contrast T1-weighted MRI predicts chronic radiofrequency ablation lesions. J Cardiovasc Electrophysiol. 2018;29:1556–62.CrossRef
39.
Zghaib T, Malayeri AA, Ipek EG, Habibi M, Huang D, Balouch MA, et al. Visualization of acute edema in the left atrial myocardium after radiofrequency ablation: application of a novel high-resolution 3-dimensional magnetic resonance imaging sequence. Heart Rhythm. 2018;15:1189–97.CrossRef
40.
Ghafoori E, Kholmovski EG, Thomas S, Silvernagel J, Angel N, Hu N, et al. Characterisation of gadolinium contrast enhancement of radiofrequency ablation lesions in predicting edema and chronic lesion size. Circ Arrhythm Electrophysiol. 2017;10:e005599.CrossRef
41.
Celik H, Ramanan V, Barry J, Ghate S, Leber V, Oduneye S, et al. Intrinsic contrast for characterisation of acute radiofrequency ablation lesions. Circ Arrhythm Electrophysiol. 2014;7:718–27.CrossRef
42.
Guttman MA, Tao S, Fink S, Kolandaivelu A, Halperin HR, Herzka DA. Non-contrast enhanced T1-weighted MRI of myocardial radiofrequency ablation lesions. Magn Reson Med. 2018;79:879–89.CrossRef
43.
Krahn PRP, Singh SM, Ramanan V, Biswas L, Yak N, Anderson KJT, et al. Cardiovascular magnetic resonance guided ablation and intra-procedural visualisation of evolving radiofrequency lesions in the left ventricle. J Cardiovasc Magn Reson. 2018;20:20.CrossRef
44.
de Senneville BD, Roujol S, Jais P, Moonen CT, Herigault G, Quesson B. Feasibility of fast MR-thermometry during cardiac radiofrequency ablation. NMR Biomed. 2012;25:556–62.CrossRef
45.
Rieke V, Pauly Butts K. MR thermometry. J Magn Reson Imaging. 2008;27:376–90.CrossRef
46.
Ishihara Y, Calderon A, Watanabe H, Okamoto K, Suzuki Y, Kuroda K, et al. A precise and fast temperature mapping using water proton chemical shift. Magn Reson Med. 1995;34:814–23.CrossRef
47.
Sapareto SA, Dewey WC. Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys. 1984;10:787–800.CrossRef
48.
Ozenne V, Toupin S, Bour P, de Senneville BD, Lepetit-Coiffe M, Boissenin M, et al. Improved cardiac magnetic resonance thermometry and dosimetry for monitoring lesion formation during catheter ablation. Magn Reson Med. 2017;77:673–83.CrossRef
49.
• Toupin S, Bour P, Lepetit-Coiffe M, Ozenne V, de Senneville BD, Schneider R, et al. Feasibility of real-time MR thermal dose mapping for predicting radiofrequency ablation outcome in the myocardium in vivo. J Cardiovasc Magn Reson. 2017;19:–14 Evaluation of MR-thermometry and dosimetry to enable real-time assessment of ablation injury during endocardial procedures in an ovine model.
50.
de Senneville BD, Mougenot C, Moonen CT. Real-time adaptive methods for treatment of mobile organs by MRI-controlled high-intensity focused ultrasound. Magn Reson Med. 2007;57:319–30.CrossRef
51.
Roujol S, Ries M, Quesson B, Moonen C, de Senneville BD. Real-time MR-thermometry and dosimetry for interventional guidance on abdominal organs. Magn Reson Med. 2010;63:1080–7.CrossRef
52.
Kolandaivelu A, Zviman MM, Castro V, Lardo AC, Berger RD, Halperin HR. Non-invasive assessment of tissue heating during cardiac radiofrequency ablation using MRI thermography. Circ Arrhythm Electrophysiol. 2010;3:521–9.CrossRef
53.
Nordbeck P, Bauer WR, Fidler F, Warmuth M, Hiller KH, Nahrendorf M, et al. Feasibility of real-time MRI with a novel carbon catheter for interventional electrophysiology. Circ Arrhythm Electrophysiol. 2009;2:258–67.CrossRef
54.
Hoffmann BA, Koops A, Rostock T, Mullerleile K, Steven D, Karst R, et al. Interactive real-time mapping and catheter ablation of the cavotricuspid isthmus guided by magnetic resonance imaging in a porcine model. Eur Heart J. 2010;31:450–6.CrossRef
55.
Vergara GR, Vijayakumar S, Kholmovski EG, Blauer JJ, Guttman MA, Gloschat C, et al. Real-time magnetic resonance imaging-guided radiofrequency atrial ablation and visualisation of lesion formation at 3 tesla. Heart Rhythm. 2011;8:295–303.CrossRef
56.
• Sommer P, Grothoff M, Eitel C, Gaspar T, Piorkowski C, Gutberlet M, et al. Feasibility of real-time magnetic resonance imaging-guided electrophysiology studies in humans. Europace. 2013;15:101–8 First description of MR-guided atrial flutter ablation in humans.CrossRef
57.
Hosseini SM, Rozen G, Saleh A, Vaid J, Biton Y, Moazzami K, et al. Catheter ablation for cardiac arrhythmias: utilization and in-hospital complications, 2000 to 2013. JACC Clin Electrophysiol. 2017;3:1240–8.CrossRef
58.
Schmidt EJ, Mallozzi RP, Thiagalingam A, Holmvang G, d’Avila A, Guhde R, et al. Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking. Circ Arrhythm Electrophysiol. 2009;2:695–704.CrossRef
59.
• Kholmovski EG, Coulombe N, Silvernagel J, Angel N, Parker D, Macleod R, et al. Real-time MRI-guided cardiac cryo-ablation: a feasibility study. J Cardiovasc Electrophysiol. 2016;27:602–8 First description of real-time MRI-guided cryoablation.CrossRef
60.
Lichter J, Kholmovski EG, Coulombe N, Ghafoori E, Kamali R, MacLeod R et al. Real-time magnetic resonance imaging-guided cryoablation of the pulmonary veins with acute freeze-zone and chronic lesion assessment. Europace 2019;21:154–62.
61.
Arepally A, Karmarkar PV, Weiss C, Rodriguez ER, Lederman RJ, Atalar E. Magnetic resonance image-guided trans-septal puncture in a swine heart. J Magn Reson Imaging. 2005;21:463–7.CrossRef
62.
Razavi R, Hill DL, Keevil SF, Miquel ME, Muthurangu V, Hedge S, et al. Cardiac catheterisation guided by MRI in children and adults with congenital heart disease. Lancet. 2003;362:1877–82.CrossRef
63.
Santangeli P, Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou WS, et al. Early mortality after catheter ablation of ventricular tachycardia in patients with structural heart disease. J Am Coll Cardiol. 2017;69:2105–15.CrossRef
64.
• Schmidt EJ, Watkins RD, Zviman MM, Guttman MA, Wang W, Halperin HA. A magnetic resonance imaging-conditional external cardiac defibrillator for resuscitation within the magnetic resonance imaging scanner bore. Circ Cardiovasc Imaging. 2016;9:e005091 Pre-clinical development of a MR-compatible defibrillation system.CrossRef
65.
Tilz RR, Lenarczyk R, Scherr D, Haugaa KH, Iliodromitis K, Purerfellner H, et al. Management of ventricular tachycardia in the ablation era: results of the European Heart Rhythm Association survey. Europace. 2018;20:209–13.CrossRef
66.
Nazarian S, Hansford R, Rahsepar AA, Weltin V, McVeigh D, Gucuk Ipek E, et al. Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med. 2017;377:2555–64.CrossRef
67.
Ranjan R, McGann CJ, Jeong EK, Hong K, Kholmovski EG, Blauer J, et al. Wideband late gadolinium enhanced magnetic resonance imaging for imaging myocardial scar without image artefacts induced by implantable cardioverter-defibrillator: a feasibility study at 3T. Europace. 2015;17:483–8.CrossRef
68.
Do DH, Eyvazian V, Bayoneta AJ, Hu P, Finn JP, Bradfield JS, et al. Cardiac magnetic resonance imaging using wideband sequences in patients with non-conditional cardiac implanted electronic devices. Heart Rhythm. 2018;15:218–25.CrossRef
69.
Dukkipati SR, Mallozzi R, Schmidt EJ, Holmvang G, d’Avila A, Guhde R, et al. Electroanatomic mapping of the left ventricle in a porcine model of chronic myocardial infarction with magnetic resonance-based catheter tracking. Circulation. 2008;118:853–62.CrossRef
Metadata
Title
Advances in Real-Time MRI–Guided Electrophysiology
Authors
Rahul K. Mukherjee
Henry Chubb
Sébastien Roujol
Reza Razavi
Mark D. O’Neill
Publication date
01-02-2019
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 2/2019
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-019-9481-9

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