Identification and acute targeting of gaps in atrial ablation lesion sets using a real-time magnetic resonance imaging system

Ravi Ranjan, Eugene G. Kholmovski, Joshua Blauer, Sathya Vijayakumar, Nelly A. Volland, Mohamed E. Salama, Dennis L. Parker, Rob MacLeod, Nassir F. Marrouche

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Background: Radiofrequency ablation is routinely used to treat cardiac arrhythmias, but gaps remain in ablation lesion sets because there is no direct visualization of ablation-related changes. In this study, we acutely identify and target gaps using a real-time magnetic resonance imaging (RT-MRI) system, leading to a complete and transmural ablation in the atrium. Methods and Results: A swine model was used for these studies (n=12). Ablation lesions with a gap were created in the atrium using fluoroscopy and an electroanatomic system in the first group (n=5). The animal was then moved to a 3-tesla MRI system where high-resolution late gadolinium enhancement MRI was used to identify the gap. Using an RT-MRI catheter navigation and visualization system, the gap area was ablated in the MR scanner. In a second group (n=7), ablation lesions with varying gaps in between were created under RT-MRI guidance, and gap lengths determined using late gadolinium enhancement MR images were correlated with gap length measured from gross pathology. Gaps up to 1.0 mm were identified using gross pathology, and gaps up to 1.4 mm were identified using late gadolinium enhancement MRI. Using an RT-MRI system with active catheter navigation gaps can be targeted acutely, leading to lesion sets with no gaps. The correlation coefficient (R2) between the gap length was identified using MRI, and the gross pathology was 0.95. Conclusions: RT-MRI system can be used to identify and acutely target gaps in atrial ablation lesion sets. Acute targeting of gaps in ablation lesion sets can potentially lead to significant improvement in clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1130-1135
Number of pages6
JournalCirculation: Arrhythmia and Electrophysiology
Volume5
Issue number6
DOIs
StatePublished - Dec 1 2012

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Keywords

  • Ablation
  • Atrial fibrillation arrhythmia
  • Magnetic resonance imaging
  • Real time magnetic resonance imaging
  • Real-time imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ranjan, R., Kholmovski, E. G., Blauer, J., Vijayakumar, S., Volland, N. A., Salama, M. E., Parker, D. L., MacLeod, R., & Marrouche, N. F. (2012). Identification and acute targeting of gaps in atrial ablation lesion sets using a real-time magnetic resonance imaging system. Circulation: Arrhythmia and Electrophysiology, 5(6), 1130-1135. https://doi.org/10.1161/CIRCEP.112.973164