Published Online
on June 23, 2008

A more recent version of this article appeared on July 15, 2008

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Submitted on September 28, 2007
Accepted on April 25, 2008

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, and 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.

^* To whom correspondence should be addressed. E-mail: snazarian{at}jhmi.edu.

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.

Key words: electrophysiology • magnetic resonance imaging • magnetic resonance imaging, interventional

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

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