Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking

Ehud Schmidt, Richard P. Mallozzi, Aravinda Thiagalingam, Godtfred Holmvang, Andre D'Avila, Renee Guhde, Robert Darrow, Glenn S. Slavin, Maggie M. Fung, Jeremy Dando, Lori Foley, Charles L. Dumoulin, Vivek Y. Reddy

Research output: Contribution to journalArticle

Abstract

Background-The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node. Methods and Results-One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block. Conclusions-LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions. (Circ Arrhythm Electrophysiol. 2009;2:695-704.)

Original languageEnglish (US)
Pages (from-to)695-704
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume2
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Atrioventricular Node
Heart Atria
Pulmonary Veins
Magnetic Resonance Spectroscopy
Swine
Catheters
Catheter Ablation
Equipment and Supplies
Atrioventricular Block
Electrophysiology
Punctures
Electrocardiography
X-Rays
Wounds and Injuries

Keywords

  • Catheter ablation
  • Electrophysiology mapping
  • MRI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking. / Schmidt, Ehud; Mallozzi, Richard P.; Thiagalingam, Aravinda; Holmvang, Godtfred; D'Avila, Andre; Guhde, Renee; Darrow, Robert; Slavin, Glenn S.; Fung, Maggie M.; Dando, Jeremy; Foley, Lori; Dumoulin, Charles L.; Reddy, Vivek Y.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 2, No. 6, 12.2009, p. 695-704.

Research output: Contribution to journalArticle

Schmidt, E, Mallozzi, RP, Thiagalingam, A, Holmvang, G, D'Avila, A, Guhde, R, Darrow, R, Slavin, GS, Fung, MM, Dando, J, Foley, L, Dumoulin, CL & Reddy, VY 2009, 'Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking', Circulation: Arrhythmia and Electrophysiology, vol. 2, no. 6, pp. 695-704. https://doi.org/10.1161/CIRCEP.109.882472
Schmidt, Ehud ; Mallozzi, Richard P. ; Thiagalingam, Aravinda ; Holmvang, Godtfred ; D'Avila, Andre ; Guhde, Renee ; Darrow, Robert ; Slavin, Glenn S. ; Fung, Maggie M. ; Dando, Jeremy ; Foley, Lori ; Dumoulin, Charles L. ; Reddy, Vivek Y. / Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking. In: Circulation: Arrhythmia and Electrophysiology. 2009 ; Vol. 2, No. 6. pp. 695-704.
@article{61f4256a8dbe4b14876a00546c6534dc,
title = "Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking",
abstract = "Background-The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node. Methods and Results-One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block. Conclusions-LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions. (Circ Arrhythm Electrophysiol. 2009;2:695-704.)",
keywords = "Catheter ablation, Electrophysiology mapping, MRI",
author = "Ehud Schmidt and Mallozzi, {Richard P.} and Aravinda Thiagalingam and Godtfred Holmvang and Andre D'Avila and Renee Guhde and Robert Darrow and Slavin, {Glenn S.} and Fung, {Maggie M.} and Jeremy Dando and Lori Foley and Dumoulin, {Charles L.} and Reddy, {Vivek Y.}",
year = "2009",
month = "12",
doi = "10.1161/CIRCEP.109.882472",
language = "English (US)",
volume = "2",
pages = "695--704",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking

AU - Schmidt, Ehud

AU - Mallozzi, Richard P.

AU - Thiagalingam, Aravinda

AU - Holmvang, Godtfred

AU - D'Avila, Andre

AU - Guhde, Renee

AU - Darrow, Robert

AU - Slavin, Glenn S.

AU - Fung, Maggie M.

AU - Dando, Jeremy

AU - Foley, Lori

AU - Dumoulin, Charles L.

AU - Reddy, Vivek Y.

PY - 2009/12

Y1 - 2009/12

N2 - Background-The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node. Methods and Results-One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block. Conclusions-LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions. (Circ Arrhythm Electrophysiol. 2009;2:695-704.)

AB - Background-The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node. Methods and Results-One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block. Conclusions-LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions. (Circ Arrhythm Electrophysiol. 2009;2:695-704.)

KW - Catheter ablation

KW - Electrophysiology mapping

KW - MRI

UR - http://www.scopus.com/inward/record.url?scp=73949133677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73949133677&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.109.882472

DO - 10.1161/CIRCEP.109.882472

M3 - Article

C2 - 19841033

AN - SCOPUS:73949133677

VL - 2

SP - 695

EP - 704

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 6

ER -