Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology Advances Toward Clinical Translation
Interventional Cardiac Magnetic Resonance Imaging in Electrophysiology Advances Toward Clinical Translation
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DOI：
10.1161/circep.114.002371
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发表时间：
2015-02-01
影响因子：
8.4
通讯作者：
Gotte, Marco
中科院分区：
文献类型：
--
作者：
Bhagirath, Pranav;van der Graaf, Maurits;Gotte, Marco
204环状节律电生理2015年2月重做程序。最近的研究，基于MRI技术，包括T2和晚期Gd增强，已经提出了对这一现象的解释。9、12射频消融术中有水肿、坏死形成。9、16消融后，水肿逐渐消失，相邻消融灶之间的间隙明显。这些间隙或不完全隔离的区域会导致心律失常的复发。提前确定差距可以大大简化重做过程(图1)。12然而，这需要一个稳健的成像战略来识别差距。此外，生成的GAP信息的集成需要容易地集成到eAM系统中。遗憾的是，当前的EAM系统不提供此功能。可以肯定的是，尽管有各种技术进步，但目前的电生理学和消融治疗和评估策略仍有必要进一步改进。在很大程度上，这些发展(例如，改进的程序指导、减少辐射暴露和程序效果的评估)在理论上可以通过在ICMR环境中操作来实现。ICMR在电生理学ICMR中允许综合使用术前三维(3D)解剖扫描，以帮助指导活动的跟踪导管、围手术期相关解剖的交互式多平面可视化、消融损伤范围的可视化以及并发症的评估。结合这些信息的治疗策略可能会通过减少程序时间和提高(治疗)效果，包括减少重做程序，潜在地改进电生理程序。少数中心探索了在MRI环境中执行电生理程序(诊断和消融)的(临床)可能性(绝大多数中心在1.5特斯拉[T]下；表1)。这些研究中的大多数是在动物身上进行的。到目前为止，在人类身上进行的有限数量的(安全性)研究是成功的，而且并不复杂。然而，每个研究小组得出的结论是，在常规执行ICMR引导的消融手术之前，需要克服以下挑战：(1)需要对设备(如通信耳机、导管和测绘系统)进行修改，以确保与MR的兼容性，并允许主动跟踪；(2)图像采集协议和重建框架需要标准化，以及(3)需要对现有的操作和安全工作流程进行大量修改。
204 Circ Arrhythm Electrophysiol February 2015 redo procedures. Recent studies, based on MRI techniques including T2 and late gadolinium enhancement, have proposed an explanation for this phenomenon. 9, 12 During radiofrequency ablation there is formation of edema and necrosis. 9, 16 After ablation, edema gradually disappears and gaps between adjacent ablation lesions become apparent. These gaps or areas with incomplete isolation result in recurrence of arrhythmia. Identification of gaps in advance may facilitate redo procedures substantially (Figure 1). 12 However, this requires a robust imaging strategy for gap identification. Furthermore, the integration of the generated gap information needs to be easily integrated into the EAM system. Current EAM systems unfortunately do not offer this functionality. It is safe to conclude that despite various technological advances, there is substantial need for further improvements in the current electrophysiology and ablation treatment and evaluation strategy. To a large extent, these developments (eg, improved procedural guidance, reduction of radiation exposure, and evaluation of procedural efficacy) could theoretically be achieved by operating in an iCMR environment. iCMR in Electrophysiology iCMR allows for integrated use of preprocedural 3-dimensional (3D) anatomic scans to help guidance of active tracked catheters, periprocedural interactive multiplanar visualization of relevant anatomy and visualization of the extent of ablation lesion, as well as evaluation of complications. The therapeutic strategy incorporating these information could potentially improve the electrophysiology procedure by reducing procedural time and increasing (therapeutic) efficacy, including less redo procedures. A limited number of centers have explored the (clinical) possibilities toward performing electrophysiology procedures (diagnostic and ablation) in an MRI environment (the vast majority at 1.5 Tesla [T]; Table 1). The majority of these studies have been performed in animals. To date, the limited number of (safety) studies conducted in humans has been successful and uncomplicated. However, each research group concludes that before performing iCMR-guided ablation procedures on a routine basis, the following challenges need to be overcome:(1) equipment (eg, communication headsets, catheters and mapping systems) needs to be modified to ensure MR compatibility and allow active tracking possibilities,(2) image acquisition protocols and reconstruction frameworks need to be standardized, and (3) existing operational and safety workflow requires considerable modification.