Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking – experience with 14 cases
To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access.
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.
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.
Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking.
• 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.
KeywordsMagnetic resonance imaging, interventional Catheter ablation, radiofrequency Cardiac electrophysiology Atrial fibrillation Animal experiments
Abbreviations and acronyms
Cardiac Magnetic Resonance
Digital amplifier stimulator
European Society of Cardiology
Federation of European Laboratory Animal Science Association
Specific absorption rate
Steady state free precession
MR imaging conditional catheters were provided by Imricor Medical Systems (Burnsville, MN, USA). The Interventional MRI Suite (iSuite) research prototype was provided by Philips.
The scientific guarantor of this publication is Prof. Matthias Gutberlet – Head of department Radiology.
The authors of this manuscript declare relationships with the following companies:
Matthias Grothoff: Lecturing fees from Siemens and Bracco
Matthias Gutberlet: Lecturing fees from Siemens, Philips, Bayer and Bracco
Bernhard Schnackenburg is an employee of Philips GmbH, Hamburg, Germany.
Steffen Weiss and Sascha Krueger are employees of Philips GmbH Innovative Technologies, Hamburg, Germany.
Philipp Sommer: Lecturing fees and travel grants by St. Jude Medical, Biosense and Imricor. Advisory board member of St. Jude Medical.
Steve Wedan and Thomas Lloyd are employees of Imricor Medical Systems.
Christian Fleiter: nothing to declare
Sebastian Hilbert: nothing to declare
Gerhard Hindricks: research grants from St. Jude Medical and Boston Scientific
Thomas Gaspar: nothing to declare
Christopher Piorkowski: nothing to declare
This study has been supported by an Imricor grant to the University of Leipzig, Germany. Catheter materials for this study were provided by Imricor. The Interventional MRI Suite (iSuite) research prototype was provided by Philips.
No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Approval from the institutional animal care committee was obtained.
Methodology: prospective, experimental, performed at one institution.
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