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Bönner F, Haberkorn S, Behm P, Schnackenburg B, Krüger S, Weiss S, Meyer C, Kelm M, Neizel-Wittke M. Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine. Int J Cardiovasc Imaging 2017; 34:431-439. [DOI: 10.1007/s10554-017-1244-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
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Velasco Forte MN, Pushparajah K, Schaeffter T, Valverde Perez I, Rhode K, Ruijsink B, Alhrishy M, Byrne N, Chiribiri A, Ismail T, Hussain T, Razavi R, Roujol S. Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT). J Cardiovasc Magn Reson 2017; 19:60. [PMID: 28806996 PMCID: PMC5556659 DOI: 10.1186/s12968-017-0368-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation. METHODS The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization. RESULTS The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization. CONCLUSIONS The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Medical Physics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Israel Valverde Perez
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Mazen Alhrishy
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tevfik Ismail
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
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Grant EK, Berul CI, Cross RR, Moak JP, Hamann KS, Sumihara K, Cronin I, O'Brien KJ, Ratnayaka K, Hansen MS, Kellman P, Olivieri LJ. Acute Cardiac MRI Assessment of Radiofrequency Ablation Lesions for Pediatric Ventricular Arrhythmia: Feasibility and Clinical Correlation. J Cardiovasc Electrophysiol 2017; 28:517-522. [PMID: 28245348 PMCID: PMC5444970 DOI: 10.1111/jce.13197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/28/2016] [Accepted: 01/18/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arrhythmia ablation with current techniques is not universally successful. Inadequate ablation lesion formation may be responsible for some arrhythmia recurrences. Periprocedural visualization of ablation lesions may identify inadequate lesions and gaps to guide further ablation and reduce risk of arrhythmia recurrence. METHODS This feasibility study assessed acute postprocedure ablation lesions by MRI, and correlated these findings with clinical outcomes. Ten pediatric patients who underwent ventricular tachycardia ablation were transferred immediately postablation to a 1.5T MRI scanner and late gadolinium enhancement (LGE) imaging was performed to characterize ablation lesions. Immediate and mid-term arrhythmia recurrences were assessed. RESULTS Patient characteristics include median age 14 years (1-18 years), median weight 52 kg (11-81 kg), normal cardiac anatomy (n = 6), d-transposition of great arteries post arterial switch repair (n = 2), anomalous coronary artery origin post repair (n = 1), and cardiac rhabdomyoma (n = 1). All patients underwent radiofrequency catheter ablation of ventricular arrhythmia with acute procedural success. LGE was identified at the reported ablation site in 9/10 patients, all arrhythmia-free at median 7 months follow-up. LGE was not visible in 1 patient who had recurrence of frequent premature ventricular contractions within 2 hours, confirmed on Holter at 1 and 21 months post procedure. CONCLUSIONS Ventricular ablation lesion visibility by MRI in the acute post procedure setting is feasible. Lesions identifiable with MRI may correlate with clinical outcomes. Acute MRI identification of gaps or inadequate lesions may provide the unique temporal opportunity for additional ablation therapy to decrease arrhythmia recurrence.
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Affiliation(s)
- Elena K Grant
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles I Berul
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Russell R Cross
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Jeffrey P Moak
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Karin S Hamann
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kohei Sumihara
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Ileen Cronin
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kendall J O'Brien
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
| | - Kanishka Ratnayaka
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Department of Cardiology, Rady Children's Hospital, San Diego, California, USA
| | - Michael S Hansen
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Kellman
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura J Olivieri
- Department of Cardiology, Children's National Health System, Washington, District of Columbia, USA
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Chubb H, Harrison JL, Weiss S, Krueger S, Koken P, Bloch LØ, Kim WY, Stenzel GS, Wedan SR, Weisz JL, Gill J, Schaeffter T, O’Neill MD, Razavi RS. Development, Preclinical Validation, and Clinical Translation of a Cardiac Magnetic Resonance - Electrophysiology System With Active Catheter Tracking for Ablation of Cardiac Arrhythmia. JACC Clin Electrophysiol 2017; 3:89-103. [DOI: 10.1016/j.jacep.2016.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/08/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Nazarian S. Cardiac Electrophysiology Procedures, Known Unknowns, and Unknown Unknowns. JACC Clin Electrophysiol 2017; 3:104-106. [DOI: 10.1016/j.jacep.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
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Chubb H, Williams SE, Whitaker J, Harrison JL, Razavi R, O'Neill M. Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology. Arrhythm Electrophysiol Rev 2017; 6:85-93. [PMID: 28845235 DOI: 10.15420/aer.2017.1.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.
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Affiliation(s)
| | - Steven E Williams
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James L Harrison
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mark O'Neill
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 2016; 27:1954-1962. [PMID: 27553931 DOI: 10.1007/s00330-016-4560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
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.
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Rogers T, Mahapatra S, Kim S, Eckhaus MA, Schenke WH, Mazal JR, Campbell-Washburn A, Sonmez M, Faranesh AZ, Ratnayaka K, Lederman RJ. Transcatheter Myocardial Needle Chemoablation During Real-Time Magnetic Resonance Imaging: A New Approach to Ablation Therapy for Rhythm Disorders. Circ Arrhythm Electrophysiol 2016; 9:e003926. [PMID: 27053637 DOI: 10.1161/circep.115.003926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation for ventricular arrhythmias is limited by inability to visualize tissue destruction, by reversible conduction block resulting from edema surrounding lesions, and by insufficient lesion depth. We hypothesized that transcatheter needle injection of caustic agents doped with gadolinium contrast under real-time magnetic resonance imaging (MRI) could achieve deep, targeted, and irreversible myocardial ablation, which would be immediately visible. METHODS AND RESULTS Under real-time MRI guidance, ethanol or acetic acid was injected into the myocardium of 8 swine using MRI-conspicuous needle catheters. Chemoablation lesions had identical geometry by in vivo and ex vivo MRI and histopathology, both immediately and after 12 (7-17) days. Ethanol caused stellate lesions with patchy areas of normal myocardium, whereas acetic acid caused homogeneous circumscribed lesions of irreversible necrosis. Ischemic cardiomyopathy was created in 10 additional swine by subselective transcoronary ethanol administration into noncontiguous territories. After 12 (8-15) days, real-time MRI-guided chemoablation-with 2 to 5 injections to create a linear lesion-successfully eliminated the isthmus and local abnormal voltage activities. CONCLUSIONS Real-time MRI-guided chemoablation with acetic acid enabled the intended arrhythmic substrate, whether deep or superficial, to be visualized immediately and ablated irreversibly. In an animal model of ischemic cardiomyopathy, obliteration of a conductive isthmus both anatomically and functionally and abolition of local abnormal voltage activities in areas of heterogeneous scar were feasible. This represents the first report of MRI-guided myocardial chemoablation, an approach that could improve the efficacy of arrhythmic substrate ablation in the thick ventricular myocardium.
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Affiliation(s)
- Toby Rogers
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Srijoy Mahapatra
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Steven Kim
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Michael A Eckhaus
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - William H Schenke
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Jonathan R Mazal
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Adrienne Campbell-Washburn
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Merdim Sonmez
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Anthony Z Faranesh
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Kanishka Ratnayaka
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.)
| | - Robert J Lederman
- From the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute (T.R., W.H.S., J.R.M., A.C.-W., M.S., A.Z.F., K.R., R.J.L.) and Division of Veterinary Resources (M.A.E.), National Institutes of Health, Bethesda, MD; Global Medical Affairs (S.M.) and Therapy Development (S.K.), St Jude Medical, St Paul, MN; and Department of Cardiology, Children's National Medical Center, Washington, DC (K.R.).
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Nedios S, Sommer P, Bollmann A, Hindricks G. Advanced Mapping Systems To Guide Atrial Fibrillation Ablation: Electrical Information That Matters. J Atr Fibrillation 2016; 8:1337. [PMID: 27909489 PMCID: PMC5089464 DOI: 10.4022/jafib.1337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022]
Abstract
Catheter ablation is an established and widespread treatment for atrial fibrillation (AF). Contemporary electroanatomical mapping systems (EAMs) have been developed to facilitate mapping processes but remain limited by spatiotemporal and processing restrictions. Advanced mapping systems emerged from the need to better understand and ablate complex AF substrate, by improving the acquisition and illustration of electrophysiological information. In this review, we present you the recently advanced mapping systems for AF ablation in comparison to the established contemporary EAMs.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany
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Magnetic resonance imaging compatible remote catheter navigation system with 3 degrees of freedom. Int J Comput Assist Radiol Surg 2015; 11:1537-45. [PMID: 26704372 DOI: 10.1007/s11548-015-1337-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE To facilitate MRI-guided catheterization procedures, we present an MRI-compatible remote catheter navigation system that allows remote navigation of steerable catheters with 3 degrees of freedom. METHODS The system consists of a user interface (master), a robot (slave), and an ultrasonic motor control servomechanism. The interventionalist applies conventional motions (axial, radial and plunger manipulations) on an input catheter in the master unit; this user input is measured and used by the servomechanism to control a compact catheter manipulating robot, such that it replicates the interventionalist's input motion on the patient catheter. The performance of the system was evaluated in terms of MRI compatibility (SNR and artifact), feasibility of remote navigation under real-time MRI guidance, and motion replication accuracy. RESULTS Real-time MRI experiments demonstrated that catheter was successfully navigated remotely to desired target references in all 3 degrees of freedom. The system had an absolute value error of [Formula: see text]1 mm in axial catheter motion replication over 30 mm of travel and [Formula: see text] for radial catheter motion replication over [Formula: see text]. The worst case SNR drop was observed to be [Formula: see text]3 %; the robot did not introduce any artifacts in the MR images. CONCLUSION An MRI-compatible compact remote catheter navigation system has been developed that allows remote navigation of steerable catheters with 3 degrees of freedom. The proposed system allows for safe and accurate remote catheter navigation, within conventional closed-bore scanners, without degrading MR image quality.
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