Abstract 2245: Interventional Electrophysiology Studies And Ablation Therapy Under Real Time MRI Guidance - Early Detection Of Complications
Background: Cardiac magnetic resonance imaging (MRI) offers 3D real time imaging with unsurpassed soft tissue contrast without X-ray exposure. However, electrophysiological (EP) examinations of patients with rhythm disorders and ablation procedures are still not possible in the MRI environment. To minimize safety concerns and imaging artifacts, we aimed at developing a setup including catheters for interventional EP based on carbon technology.
Methods and Results: The setup, which includes a steerable carbon catheter, was tested for safety, image distortion, pacing and sensing properties, and feasibility of ablation at 1.5 Tesla. MR imaging was performed in two different 1.5-T whole-body scanners. To assess unintentional heating of the catheters by radio frequency (RF) pulses of the MR scanner in vitro, a fluoroptic thermometry system was used to record heating at the catheter tip. In vivo tests for pacing and sensing properties and ablation therapy were performed in eight pigs. There was no significant heating of the carbon catheters while using short, repetitive RF pulses from the MR system. Since there was no image distortion when using the carbon catheters, exact targeting of the lesion sites was possible. During imaging, pacing of in vivo pig hearts and sensing the intra cardiac electrogram was possible without any artifacts. Several RF-ablation procedures, including AV node modulation were performed successfully in the scanner. Potential complications during ablation such as perforation of the RV free wall could be monitored in real time as well.
Conclusion: Here we describe a newly developed EP technology for interventional electrophysiology based on carbon catheters. These catheters are suitable for electrophysiological diagnostic and ablation procedures. Their feasibility was demonstrated by performing safety EP studies and ablation therapy with carbon catheters in the MRI environment.