Cardiovascular magnetic resonance guided electrophysiology studies
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BioMed Central
Open Access
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Cardiovascular magnetic resonance guided electrophysiology studies Aravindan Kolandaivelu, Albert C Lardo and Henry R Halperin* Address: Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD 21205, USA Email: Aravindan Kolandaivelu - [email protected]; Albert C Lardo - [email protected]; Henry R Halperin* - [email protected] * Corresponding author
Published: 6 July 2009 Journal of Cardiovascular Magnetic Resonance 2009, 11:21
doi:10.1186/1532-429X-11-21
Received: 5 June 2009 Accepted: 6 July 2009
This article is available from: http://www.jcmr-online.com/content/11/1/21 © 2009 Kolandaivelu et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients.
Introduction Radiofrequency (RF) catheter ablation has advanced over the last 25 years from an experimental procedure to the first line treatment for a number of cardiac arrhythmias including atrio-ventricular reentrant tachycardia, accessory pathway associated tachycardias, and typical atrial flutter [1]. These procedures are typically guided by positioning electrode catheters using x-ray fluoroscopy and using these catheters to observe the propagation of electrical activity through the heart. Successful targeting of ablation primarily to the anatomic arrhythmia substrate, as opposed to mapping and targeting ablation based on electrogram characteristics, began with recognition that common atrial flutter passes through a narrow structure known as the cavo-tricuspid isthmus [2]. By directing
ablation to interrupt conduction through this region, hig
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