Henry Chubb1, James L Harrison2, Steffen Weiss2, Sascha Krueger2, Peter Koken2, Lars Ø Bloch3, Won Yong Kim3, Gregg S Stenzel4, Steven R Wedan4, Jennifer L Weisz4, Jaswinder Gill5, Tobias Schaeffter1, Mark D O'Neill5, Reza S Razavi6. 1. Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom. 2. Research Laboratories, Philips Technologie GmbH, Hamburg, Germany. 3. Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. 4. Imricor Medical Systems, Inc., Burnsville, Minnesota. 5. Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom. 6. Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom. Electronic address: reza.razavi@kcl.ac.uk.
Abstract
OBJECTIVES: This study sought to develop an actively tracked cardiac magnetic resonance-guided electrophysiology (CMR-EP) system and perform first-in-human clinical ablation procedures. BACKGROUND: CMR-EP offers high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Implementation of active tracking, where catheter position is continuously transmitted in a manner analogous to electroanatomic mapping (EAM), is crucial for CMR-EP to take the step from theoretical technology to practical clinical tool. METHODS: The setup integrated a clinical 1.5-T scanner, an EP recording and ablation system, and a real-time image guidance platform with components undergoing ex vivo validation. The full system was assessed using a preclinical study (5 pigs), including mapping and ablation with histological validation. For the clinical study, 10 human subjects with typical atrial flutter (age 62 ± 15 years) underwent MR-guided cavotricuspid isthmus (CTI) ablation. RESULTS: The components of the CMR-EP system were safe (magnetically induced torque, radiofrequency heating) and effective in the CMR environment (location precision). Targeted radiofrequency ablation was performed in all animals and 9 (90%) humans. Seven patients had CTI ablation completed using CMR guidance alone; 2 patients required completion under fluoroscopy, with 2 late flutter recurrences. Acute and chronic CMR imaging demonstrated efficacious lesion formation, verified with histology in animals. Anatomic shape of the CTI was an independent predictor of procedural success. CONCLUSIONS: CMR-EP using active catheter tracking is safe and feasible. The CMR-EP setup provides an effective workflow and has the potential to change the way in which ablation procedures may be performed.
OBJECTIVES: This study sought to develop an actively tracked cardiac magnetic resonance-guided electrophysiology (CMR-EP) system and perform first-in-human clinical ablation procedures. BACKGROUND: CMR-EP offers high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Implementation of active tracking, where catheter position is continuously transmitted in a manner analogous to electroanatomic mapping (EAM), is crucial for CMR-EP to take the step from theoretical technology to practical clinical tool. METHODS: The setup integrated a clinical 1.5-T scanner, an EP recording and ablation system, and a real-time image guidance platform with components undergoing ex vivo validation. The full system was assessed using a preclinical study (5 pigs), including mapping and ablation with histological validation. For the clinical study, 10 human subjects with typical atrial flutter (age 62 ± 15 years) underwent MR-guided cavotricuspid isthmus (CTI) ablation. RESULTS: The components of the CMR-EP system were safe (magnetically induced torque, radiofrequency heating) and effective in the CMR environment (location precision). Targeted radiofrequency ablation was performed in all animals and 9 (90%) humans. Seven patients had CTI ablation completed using CMR guidance alone; 2 patients required completion under fluoroscopy, with 2 late flutter recurrences. Acute and chronic CMR imaging demonstrated efficacious lesion formation, verified with histology in animals. Anatomic shape of the CTI was an independent predictor of procedural success. CONCLUSIONS: CMR-EP using active catheter tracking is safe and feasible. The CMR-EP setup provides an effective workflow and has the potential to change the way in which ablation procedures may be performed.
Authors: Michael A Guttman; Susumu Tao; Sarah Fink; Rick Tunin; Ehud J Schmidt; Daniel A Herzka; Henry R Halperin; Aravindan Kolandaivelu Journal: Magn Reson Med Date: 2019-09-30 Impact factor: 4.668
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Authors: Geertruida P Bijvoet; Robert J Holtackers; Hedwig M J M Nies; Casper Mihl; Sevasti-Maria Chaldoupi Journal: Int J Cardiol Heart Vasc Date: 2022-06-28
Authors: Rahul K Mukherjee; Sébastien Roujol; Henry Chubb; James Harrison; Steven Williams; John Whitaker; Louisa O'Neill; John Silberbauer; Radhouene Neji; Rainer Schneider; Thomas Pohl; Tom Lloyd; Mark O'Neill; Reza Razavi Journal: Europace Date: 2018-09-01 Impact factor: 5.214
Authors: Rahul K Mukherjee; Caroline Mendonca Costa; Radhouene Neji; James L Harrison; Iain Sim; Steven E Williams; John Whitaker; Henry Chubb; Louisa O'Neill; Rainer Schneider; Tom Lloyd; Thomas Pohl; Sébastien Roujol; Steven A Niederer; Reza Razavi; Mark D O'Neill Journal: Europace Date: 2019-09-01 Impact factor: 5.214