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Aer precision transmission12/4/2023 2,11 Findings from some studies have been interpreted to suggest that successful ablation of fibrotic regions, distant to the pulmonary veins (PVs), may help improve AF ablation success rates. Although the atrial wall is thinner, native fibrosis and ablation scar can be identified using primarily threedimensional LGE techniques. 10Įmerging data also suggest that CMR imaging may be used to guide atrial ablation procedures. Conventional LGE resolutions (typically 1.3 x 1.3 mm in-plane) are unlikely to be sufficient, 9 and further work is required to establish a firm correlation between CMR-derived scar and critical isthmuses. Developments in mapping catheter technologies, using smaller and more tightly spaced electrodes, have demonstrated the importance of the fine myocardial architecture in the perpetuation of VT. 6–8 However, caution is required in the direct extrapolation of the imaging to the electrophysiological substrate. ![]() 4,5 In particular, the scar border zone has been shown to be critical in the perpetuation of the arrhythmia and its abolition forms the basis of substrate-based VT ablation. Ventricular tachycardia (VT) in ischaemic cardiomyopathy occurs due to scar-related re-entry and scar can be visualised using late gadolinium enhancement (LGE) techniques. ![]() Ventricular substrate is generally more amenable than atrial to evaluation by CMR owing to increased wall thickness and consequent higher contrast between healthy and pathological tissue. 3 MR-guided EP presents a modality in which CMR-derived substrate could be used more accurately and intuitively to guide procedures. However, improvements in clinical ablation outcome with the use of CMRderived substrate information have been modest. Broadly speaking, these benefits can be divided into three main areas: improved precision of ablation targeting (substrate identification), improved intra-procedural guidance and improved assessment of ablation lesion formation.īoth ventricular and atrial arrhythmogenic substrates have been identified on cardiovascular magnetic resonance (CMR) imaging, 1,2 and the implementation of CMR data regarding local myocardial characterisation is increasingly used to guide procedures. However, the environment can present challenges and is an expensive procedure therefore, all the benefits of MR-guided EP must be fully considered to justify the additional difficulties and expense. MRI techniques offer a high soft-tissue contrast-to-noise ratio (CNR) in comparison with that seen with X-ray, computed tomography (CT) and ultrasound. Potential Benefits of MR-guided Electrophysiological Procedures This review focuses on the technical considerations for the performance of EP procedures under MRI guidance (MR-guided EP). Cardiac electrophysiological (EP) procedures add a further dimension, as the accurate detection of intracardiac electrograms must be performed in a highly active electromagnetic environment. For general cardiac interventions, the visualisation of thin, mobile structures presents particular challenges for MRI guidance. ![]() Combined with the avoidance of radiation exposure, the potential for functional assessment and the ability to exploit MR signals for calculation of the location of interventional instruments, it is clear that the implementation of interventional MRI will continue to grow. For use of the materials, or their dissemination, please contact specifying the exact item and purpose of use.Interventional magnetic resonance imaging (MRI) is a growing field, and the strength of MRI guidance for procedures rests fundamentally in the high-contrast imaging of soft tissue structures. 2030 Agenda for Sustainable Developmentīelow you will find a list of promotional and outreach materials related to the UN Convention on the Rights of Persons with Disabilities, as well as related statistics and meetings.General Assembly Reports and Resolutions.State Of The World’s Indigenous Peoples.United Nations Permanent Forum on Indigenous Issues (UNPFII).Open-Ended Working Group (OEWG) on Ageing.Conference of States Parties to the Convention on the Rights of Persons with Disabilities (COSP).Commission for Social Development (CSocD).
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