Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation.
Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation.
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DOI：
10.1093/europace/euy040
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发表时间：
2018-11-01
期刊：
影响因子：
--
通讯作者：
O'Neill MD
中科院分区：
文献类型：
--
作者：
Mukherjee RK;Whitaker J;Williams SE;Razavi R;O'Neill MD
导管消融在室性心动过速(VT)患者的治疗中起着重要的作用，但长期成功率有限。磁共振成像(MRI)可以提供有价值的解剖和功能信息，并有可能改善消融靶点的识别。目前磁共振成像技术的一个主要局限性是识别引起室上性心动过速的组织区域所需的空间分辨率，但最近的发展导致了新的策略，这可能会改善底物评估。在电生理过程中可以利用从MRI获得的详细信息的可能方式包括图像集成或在实时MRI指导下执行过程。图像集成允许将术前磁共振(MR)图像与电解剖图配准，以帮助指导VT消融，并已在初步研究中显示出希望。然而，在这一过程中，由于所使用的配准技术、MRI时间和消融过程中脑室几何形状的变化、呼吸和心脏运动等原因，可能会出现多个错误。由于峡部可能只有几毫米宽，减少这些误差可能是改善VT消融结果的关键。实时MR引导的介入治疗已经成为一种替代的解决方案，以解决预先获取的成像来指导消融的局限性。现在有越来越多的文献描述了实时MR引导电生理学的可行性、技术和潜在的应用。我们回顾了实时MR引导的介入治疗是否可以应用于VT消融，以及需要克服的潜在挑战。
Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.
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DOI：
10.1002/jmri.25749
发表时间：
2017-10
期刊：
Journal of magnetic resonance imaging : JMRI
影响因子：
--
作者：
Campbell-Washburn AE;Tavallaei MA;Pop M;Grant EK;Chubb H;Rhode K;Wright GA
通讯作者：
Wright GA
影响因子：
14
作者：
Disertori, Marcello;Rigoni, Marta;Ravelli, Flavia
通讯作者：
Ravelli, Flavia
影响因子：
39.3
作者：
Andreu, David;Tomas Ortiz-Perez, Jose;Berruezo, Antonio
通讯作者：
Berruezo, Antonio
影响因子：
4.4
作者：
Arepally, A;Karmarkar, PV;Atalar, E
通讯作者：
Atalar, E
影响因子：
20.1
作者：
Ashikaga, Hiroshi;Sasano, Tetsuo;Halperin, Henry R.
通讯作者：
Halperin, Henry R.