Matthias Grothoff1, Matthias Gutberlet2, Gerhard Hindricks3, Christian Fleiter4, Bernhard Schnackenburg5, Steffen Weiss6, Sascha Krueger6, Christopher Piorkowski7, Thomas Gaspar7, Steve Wedan8, Thomas Lloyd8, Philipp Sommer3, Sebastian Hilbert3. 1. Department of Radiology, University of Leipzig - Heart Center, Struempellstr.39, 04289, Leipzig, Germany. grothoff@gmx.de. 2. Department of Radiology, University of Leipzig - Heart Center, Struempellstr.39, 04289, Leipzig, Germany. 3. Department of Electrophysiology, University of Leipzig - Heart Center, Struempellstr.39, 04289, Leipzig, Germany. 4. Helios Klinikum Berlin-Buch, Department of Orthopaedic Surgery, Schwanebecker Chaussee 50, 13125, Berlin, Germany. 5. Philips Healthcare, Philipsstr. 14, 20099, Hamburg, Germany. 6. Philips Innovative Technologies, Roentgenstr. 24-26, 22335, Hamburg, Germany. 7. Department of Electrophysiology, University of Dresden - Heart Center, Fetscherstr. 76, 01307, Dresden, Germany. 8. Imricor Medical Systems, 400 Gateway Blvd., Burnsville, MN, 55337, USA.
Abstract
OBJECTIVES: To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. METHODS: After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. RESULTS: Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. CONCLUSIONS: Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. KEY POINTS: • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans.
OBJECTIVES: To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. METHODS: After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. RESULTS: Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. CONCLUSIONS: Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. KEY POINTS: • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans.
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