title: Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series.
abstract: Recently cardiac magnetic resonance (CMR) imaging has been found feasible for the visualization of the underlying substrate for cardiac arrhythmias as well as for the visualization of cardiac catheters for diagnostic and ablation procedures. Real-time CMR-guided cavotricuspid isthmus ablation was performed in a series of six patients using a combination of active catheter tracking and catheter visualization using real-time MR imaging.
  
  
  
  Cardiac magnetic resonance utilizing a 1.5 T system was performed in patients under deep propofol sedation. A three-dimensional-whole-heart sequence with navigator technique and a fast automated segmentation algorithm was used for online segmentation of all cardiac chambers, which were thereafter displayed on a dedicated image guidance platform. In three out of six patients complete isthmus block could be achieved in the MR scanner, two of these patients did not need any additional fluoroscopy. In the first patient technical issues called for a completion of the procedure in a conventional laboratory, in another two patients the isthmus was partially blocked by magnetic resonance imaging (MRI)-guided ablation. The mean procedural time for the MR procedure was 109 ± 58 min. The intubation of the CS was performed within a mean time of 2.75 ± 2.21 min. Total fluoroscopy time for completion of the isthmus block ranged from 0 to 7.5 min.
  
  
  
  The combination of active catheter tracking and passive real-time visualization in CMR-guided electrophysiologic (EP) studies using advanced interventional hardware and software was safe and enabled efficient navigation, mapping, and ablation. These cases demonstrate significant progress in the development of MR-guided EP procedures.
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany sebastian.hilbert@gmx.net.
authors: Sebastian
authors: S
authors: Hilbert
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany.
authors: Philipp
authors: P
authors: Sommer
authors: Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Leipzig, Germany.
authors: Matthias
authors: M
authors: Gutberlet
authors: Department of Electrophysiology, Heart Center Dresden, University of Dresden, Germany.
authors: Thomas
authors: T
authors: Gaspar
authors: Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Leipzig, Germany.
authors: Borek
authors: B
authors: Foldyna
authors: Department of Electrophysiology, Heart Center Dresden, University of Dresden, Germany.
authors: Christopher
authors: C
authors: Piorkowski
authors: Innovative Technologies, Philips, Technology GmbH, Hamburg, Germany.
authors: Steffen
authors: S
authors: Weiss
authors: Imricor Medical Systems, Burnsville, MN, USA.
authors: Thomas
authors: T
authors: Lloyd
authors: Philips GmbH, Healthcare, Hamburg, Germany.
authors: Bernhard
authors: B
authors: Schnackenburg
authors: Innovative Technologies, Philips, Technology GmbH, Hamburg, Germany.
authors: Sascha
authors: S
authors: Krueger
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany.
authors: Christian
authors: C
authors: Fleiter
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany.
authors: Ingo
authors: I
authors: Paetsch
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany.
authors: Cosima
authors: C
authors: Jahnke
authors: Department of Electrophysiology, University Leipzig - Heart Center, Strümpellstr. 39, Leipzig 04289, Germany.
authors: Gerhard
authors: G
authors: Hindricks
authors: Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Leipzig, Germany.
authors: Matthias
authors: M
authors: Grothoff
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016280:Atrial Function, Right; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D054810:Deep Sedation / Q000379:methods; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005471:Fluoroscopy; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives; D007090:Image Interpretation, Computer-Assisted; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011237:Predictive Value of Tests; D015742:Propofol; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Ablation; Active tracking; Atrial flutter; Electrophysiological study; Real-time MRI