Published Online
on August 4, 2008

A more recent version of this article appeared on August 19, 2008

This Article Full Text (PDF) All Versions of this Article: 118/8/853    most recent CIRCULATIONAHA.107.738229v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dukkipati, S. R. Articles by Reddy, V. Y. Search for Related Content PubMed PubMed Citation Articles by Dukkipati, S. R. Articles by Reddy, V. Y. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Attack MRI Scans Hazardous Substances DB LIDOCAINE Related Collections Ablation/ICD/surgery CT and MRI Arrhythmias, clinical electrophysiology, drugs Related Article

Submitted on September 1, 2007
Accepted on June 24, 2008

Electroanatomic Mapping of the Left Ventricle in a Porcine Model of Chronic Myocardial Infarction With Magnetic Resonance–Based Catheter Tracking

Srinivas R. Dukkipati MD, Richard Mallozzi PhD, Ehud J. Schmidt PhD, Godtfred Holmvang MD, Andre d'Avila MD, Renee Guhde MS, Robert D. Darrow MS, Glenn Slavin PhD, Maggie Fung MS, Zachary Malchano BS, Greg Kampa BS, Jeremy D. Dando BS, Christina McPherson BS, Thomas K. Foo PhD, Jeremy N. Ruskin MD, Charles L. Dumoulin PhD, and Vivek Y. Reddy MD^*

From the Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston (S.R.D., G.H., A.D., Z.M., C.M., J.N.R., V.Y.R.); GE Global Research, Niskayuna, NY (R.M., R.G., R.D.D., T.K.F., C.L.D); GE Healthcare Applied Science Laboratory, Boston, Mass, and Bethesda, Md (E.J.S., G.S., M.F.); and St Jude Medical, Inc, Minnetonka, Minn (G.K., J.D.D).

^* To whom correspondence should be addressed. E-mail: vreddy{at}med.miami.edu.

Background—X-ray fluoroscopy constitutes the fundamental imaging modality for catheter visualization during interventional electrophysiology procedures. The minimal tissue discriminative capability of fluoroscopy is mitigated in part by the use of electroanatomic mapping systems and enhanced by the integration of preacquired 3-dimensional imaging of the heart with computed tomographic or magnetic resonance (MR) imaging. A more ideal paradigm might be to use intraprocedural MR imaging to directly image and guide catheter mapping procedures.

Methods and Results—An MR imaging–based electroanatomic mapping system was designed to assess the feasibility of navigating catheters to the left ventricle in vivo using MR tracking of microcoils incorporated into the catheters, measuring intracardiac ventricular electrograms, and integrating this information with 3-dimensional MR angiography and myocardial delayed enhancement images to allow ventricular substrate mapping. In all animals (4 normal, and 10 chronically infarcted swine), after transseptal puncture under fluoroscopic guidance, catheters were successfully navigated to the left ventricle with MR tracking (13 to 15 frames per second) by both transseptal and retrograde aortic approaches. Electrogram artifacts related to the MR imaging gradient pulses were successfully removed with analog and digital signal processing. In all animals, it was possible to map the entire left ventricle and to project electrogram voltage amplitude maps to identify the scarred myocardium.

Conclusions—It is possible to use MR tracking to navigate catheters to the left ventricle, to measure electrogram activity, and to render accurate 3-dimensional voltage maps in a porcine model of chronic myocardial infarction, completely in the MR imaging environment. Myocardial delayed enhancement guidance provided dense sampling of the proximity of the infarct and accurate localization of complex infarcts.

Key words: catheter ablation • magnetic resonance imaging • mapping • myocardial infarction

Related Article:

Circulation: Clinical Summaries
Circulation 2008 118: 793-794. [Extract] [Full Text]

This article has been cited by other articles:

				C. E. Saikus and R. J. Lederman Interventional Cardiovascular Magnetic Resonance Imaging: A New Opportunity for Image-Guided Interventions J. Am. Coll. Cardiol. Img., November 1, 2009; 2(11): 1321 - 1331. [Abstract] [Full Text] [PDF]

				P. Nordbeck, W. R. Bauer, F. Fidler, M. Warmuth, K.-H. Hiller, M. Nahrendorf, M. Maxfield, S. Wurtz, W. Geistert, J. Broscheit, et al. Feasibility of Real-Time MRI With a Novel Carbon Catheter for Interventional Electrophysiology Circ Arrhythm Electrophysiol, June 1, 2009; 2(3): 258 - 267. [Abstract] [Full Text] [PDF]

				L. F. Tops and J. J. Bax The Year in Imaging Related to Electrophysiology J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510. [Full Text] [PDF]

				A. Pandit and N. F. Marrouche Cardiac magnetic resonance in the world of the cardiac electrophysiologist the road to real-time cardiac magnetic resonance. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 317 - 318. [Full Text] [PDF]