Epicardial electroanatomical mapping, radiofrequency ablation, and lesion imaging in the porcine left ventricle under real-time magnetic resonance imaging guidance-an in vivo feasibility study.

Autor:	Mukherjee RK; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Roujol S; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Chubb H; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Harrison J; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Williams S; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Whitaker J; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., O'Neill L; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Silberbauer J; Department of Cardiology, Brighton and Sussex University Hospital NHS Trust, Eastern Road, Brighton, UK., Neji R; Siemens Healthcare, Sir William Siemens Square, Frimley, Camberley, UK., Schneider R; Siemens Healthcare GmbH Erlangen, Germany., Pohl T; Siemens Healthcare GmbH Erlangen, Germany., Lloyd T; Imricor Medical Systems, 400 Gateway Blvd, Burnsville, MN, USA., O'Neill M; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK., Razavi R; Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2018 Sep 01; Vol. 20 (FI2), pp. f254-f262.
DOI:	10.1093/europace/eux341
Abstrakt:	Aims: Magnetic resonance imaging (MRI) is the gold standard for defining myocardial substrate in 3D and can be used to guide ventricular tachycardia ablation. We describe the feasibility of using a prototype magnetic resonance-guided electrophysiology (MR-EP) system in a pre-clinical model to perform real-time MRI-guided epicardial mapping, ablation, and lesion imaging with active catheter tracking. Methods and Results: Experiments were performed in vivo in pigs (n = 6) using an MR-EP guidance system research prototype (Siemens Healthcare) with an irrigated ablation catheter (Vision-MR, Imricor) and a dedicated electrophysiology recording system (Advantage-MR, Imricor). Following epicardial access, local activation and voltage maps were acquired, and targeted radiofrequency (RF) ablation lesions were delivered. Ablation lesions were visualized in real time during RF delivery using MR-thermometry and dosimetry. Hyper-acute and acute assessment of ablation lesions was also performed using native T1 mapping and late-gadolinium enhancement (LGE), respectively. High-quality epicardial bipolar electrograms were recorded with a signal-to-noise ratio of greater than 10:1 for a signal of 1.5 mV. During epicardial ablation, localized temperature elevation could be visualized with a maximum temperature rise of 35 °C within 2 mm of the catheter tip relative to remote myocardium. Decreased native T1 times were observed (882 ± 107 ms) in the lesion core 3-5 min after lesion delivery and relative location of lesions matched well to LGE. There was a good correlation between ablation lesion site on the iCMR platform and autopsy. Conclusion: The MR-EP system was able to successfully acquire epicardial voltage and activation maps in swine, deliver, and visualize ablation lesions, demonstrating feasibility for intraprocedural guidance and real-time assessment of ablation injury.
Databáze:	MEDLINE
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