Mapping and ablation of the pulmonary veins and cavo-tricuspid isthmus with a magnetic resonance imaging-compatible externally irrigated ablation catheter and integrated electrophysiology system

Anand N. Ganesan, Joseph B. Selvanayagam, Rajiv Mahajan, Suchi Grover, Sachin Nayyar, Anthony G. Brooks, John Finnie, Daniel Sunnarborg, Thomas Lloyd, Adhiraj Chakrabarty, Hany S. Abed, Prashanthan Sanders

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11 Citations (Scopus)

Abstract

Background: Magnetic resonance imaging (MRI)-guided interventional electrophysiology (EP) has rapidly emerged as a promising alternative to x-ray-guided ablation. We aimed to evaluate an externally irrigated MRI-compatible ablation catheter and integrated EP pacing and recording system, testing the feasibility of pulmonary vein and cavo-tricuspid isthmus ablation. Methods and Results: Externally irrigated MRI-compatible ablation and diagnostic EP catheters and an integrated EP recording system (Imricor Medical Systems, Burnsville, MN) were tested in n=11 sheep in a 1.5-T MRI scanner. Power-controlled (40 W, 120-second duration) lesions were formed at the pulmonary vein and cavo-tricuspid isthmus. Real-time intracardiac electrograms were recorded during MRI. Steady-state free precession non-breath-hold images were repeatedly acquired to guide catheter navigation. Lesion visualization was performed using noncontrast (T2-weighted turbo spin echo pulse sequence) and gadolinium-diethylene triamine pentaacetic acid-enhanced T1-weighted imaging (inversion-recovery gradient echo pulse sequence). Catheters were able to be visualized and navigated under cardiovascular magnetic resonance guidance. In total, 8±2.5 lesions (radiofrequency time, 16±4.2 minutes) were formed at the pulmonary vein ostia, and 6.5±1.3 lesions (radiofrequency time, 13±2.2 minutes) were formed at the cavo-tricuspid isthmus, with the end point of bidirectional block. The mean procedure time was 150±55 minutes. Lesion visualization with both T2W imaging and contrast-enhanced imaging correlated with sites of injury at autopsy. Conclusions: These data demonstrate the feasibility of using multiple catheters, an integrated EP pacing and recording system, and externally irrigated ablation with cardiovascular magnetic resonance guidance to undertake clinically relevant biatrial mapping and ablation.

Original languageEnglish
Pages (from-to)1136-1142
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number6
DOIs
Publication statusPublished - 1 Dec 2012

Keywords

  • Ablation
  • Catheter ablation
  • Electrophysiology
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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