title: Stereotactic magnetic resonance guidance for anatomically targeted ablations of the fossa ovalis and the left atrium.
abstract: BACKGROUND
  Targets for radiofrequency ablation (RFA) of atrial fibrillation are increasingly being selected based on anatomic considerations. Because fluoroscopy provides only limited information about the relationship between catheter positions and cardiac structures, we evaluated whether stereotactic catheter guidance might facilitate anatomical catheter navigation and RFA to the great vessels, the fossa ovalis and the left atrium (LA).
  
  
  RESULTS
  An electromagnetic catheter's position system was superimposed on three-dimensional (3D) MR images using fiducial markers. This allowed the dynamic display of the catheter position on the true anatomy of previously acquired MRI in real-time. To assess the reproducibility of RFA, repeat ablations were created at the identical anatomic site in the inferior vena cava (IVC) in 5 swine. Average distance of the repeated ablations was 4.4 +/- 2.4 mm.In five swine the catheter was anatomically guided with the MRI to the fossa ovalis and a single RFA was performed. On the pathological specimen all ablation sites were located within the fossa ovalis with an average distance of 3.9 +/- 2.1 mm from its center. In two of the experiments the ablation catheter was passed into the left atrium and anatomically targeted ablation performed in the lateral wall of the left atrial appendage. Catheter location and ablation site were confirmed by autopsy and histology.
  
  
  CONCLUSIONS
  Real-time display of the catheter position on 3D-MRI allows anatomically targeted catheter navigation and RFA in the IVC, the fossa ovalis, and the left atrium. This may facilitate anatomically based interventions like septal puncture or pulmonary vein ablation and decrease fluoroscopy times.
authors.affiliation: Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. tdickfel@jhmi.edu
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Menekhem
authors.initials: M
authors.lastname: Zviman
authors.forename: Glenn
authors.initials: G
authors.lastname: Meininger
authors.forename: Lars
authors.initials: L
authors.lastname: Lickfett
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lardo
authors.forename: Ronald
authors.initials: R
authors.lastname: Berger
authors.forename: Henry
authors.initials: H
authors.lastname: Halperin
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D013238:Stereotaxic Techniques; D013552:Swine