This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 118/3/223    most recent CIRCULATIONAHA.107.742452v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nazarian, S. Articles by Halperin, H. R. Search for Related Content PubMed PubMed Citation Articles by Nazarian, S. Articles by Halperin, H. R. Related Collections Electrophysiology Ablation/ICD/surgery CT and MRI Related Article

(Circulation. 2008;118:223-229.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Feasibility of Real-Time Magnetic Resonance Imaging for Catheter Guidance in Electrophysiology Studies

Saman Nazarian, MD^*; Aravindan Kolandaivelu, MD^*; Menekhem M. Zviman, PhD; Glenn R. Meininger, MD; Ritsushi Kato, MD; Robert C. Susil, MD, PhD; Ariel Roguin, MD, PhD; Timm L. Dickfeld, MD, PhD; Hiroshi Ashikaga, MD, PhD; Hugh Calkins, MD; Ronald D. Berger, MD, PhD; David A. Bluemke, MD, PhD; Albert C. Lardo, PhD; Henry R. Halperin, MD, MA

From the Departments of Medicine/Cardiology (S.N., A.K., M.M.Z., G.R.M., R.K., A.R., T.L.D., H.A., H.C., R.D.B., D.A.B., A.C.L., H.R.H.), Radiology (D.A.B., H.R.H.), Radiation Oncology (R.C.S.), and Biomedical Engineering (R.D.B., A.C.L., H.R.H.), Johns Hopkins Hospital, Baltimore, Md.

Correspondence to Saman Nazarian, MD, Division of Cardiology, Johns Hopkins Hospital, Carnegie 592C, 600 N Wolfe St, Baltimore, MD 21287. E-mail snazarian{at}jhmi.edu

Received September 28, 2007; accepted April 25, 2008.

Background— Compared with fluoroscopy, the current imaging standard of care for guidance of electrophysiology procedures, magnetic resonance imaging (MRI) provides improved soft-tissue resolution and eliminates radiation exposure. However, because of inherent magnetic forces and electromagnetic interference, the MRI environment poses challenges for electrophysiology procedures. In this study, we sought to test the feasibility of performing electrophysiology studies with real-time MRI guidance.

Methods and Results— An MRI-compatible electrophysiology system was developed. Catheters were targeted to the right atrium, His bundle, and right ventricle of 10 mongrel dogs (23 to 32 kg) via a 1.5-T MRI system using rapidly acquired fast gradient-echo images (5 frames per second). Catheters were successfully positioned at the right atrial, His bundle, and right ventricular target sites of all animals. Comprehensive electrophysiology studies with recording of intracardiac electrograms and atrial and ventricular pacing were performed. Postprocedural pathological evaluation revealed no evidence of thermal injury to the myocardium. After proof of safety in animal studies, limited real-time MRI-guided catheter mapping studies were performed in 2 patients. Adequate target catheter localization was confirmed via recording of intracardiac electrograms in both patients.

Conclusions— To the best of our knowledge, this is the first study to report the feasibility of real-time MRI-guided electrophysiology procedures. This technique may eliminate patient and staff radiation exposure and improve real-time soft tissue resolution for procedural guidance.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 118: 211-212. [Extract] [Full Text]

This article has been cited by other articles:

				S. S. Kim, Z. M. Hijazi, R. M. Lang, and B. P. Knight The use of intracardiac echocardiography and other intracardiac imaging tools to guide noncoronary cardiac interventions. J. Am. Coll. Cardiol., June 9, 2009; 53(23): 2117 - 2128. [Abstract] [Full Text] [PDF]

				P. Nordbeck, W. R. Bauer, F. Fidler, M. Warmuth, K.-H. Hiller, M. Nahrendorf, M. Maxfield, S. Wurtz, W. Geistert, J. Broscheit, et al. Feasibility of Real-Time MRI With a Novel Carbon Catheter for Interventional Electrophysiology Circ Arrhythmia Electrophysiol, June 1, 2009; 2(3): 258 - 267. [Abstract] [Full Text] [PDF]

				N. Akoum and N. F. Marrouche Real-time imaging in electrophysiology: from intra-cardiac echo to real-time magnetic resonance imaging Europace, May 1, 2009; 11(5): 539 - 540. [Full Text] [PDF]

				L. F. Tops and J. J. Bax The Year in Imaging Related to Electrophysiology J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510. [Full Text] [PDF]

				A. Pandit and N. F. Marrouche Cardiac magnetic resonance in the world of the cardiac electrophysiologist the road to real-time cardiac magnetic resonance. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 317 - 318. [Full Text] [PDF]

				S. Nazarian, D. A. Bluemke, and H. R. Halperin Applications of Cardiac Magnetic Resonance in Electrophysiology Circ Arrhythmia Electrophysiol, February 1, 2009; 2(1): 63 - 71. [Full Text] [PDF]

				P. Kirchhof, M. Ozgun, S. Zellerhoff, G. Monnig, L. Eckardt, K. Wasmer, W. Heindel, G. Breithardt, and D. Maintz Diastolic isthmus length and 'vertical' isthmus angulation identify patients with difficult catheter ablation of typical atrial flutter: a pre-procedural MRI study Europace, January 1, 2009; 11(1): 42 - 47. [Abstract] [Full Text] [PDF]