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MRT-basierte Katheterablation

Aktueller Stand und Ausblick

MRI-based catheter ablation

Current status and outlook

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die Fluoroskopie-gestützte Katheterablation hat sich als Standardverfahren zur Behandlung von Patienten mit Herzrhythmusstörungen etabliert. Sie unterliegt jedoch hinsichtlich der Visualisierung von arrhythmogenem Substrat und Ablationsläsionen gewissen Limitationen und geht mit einer Strahlenbelastung einher. Im Rahmen von Studien konnten erste Erfahrungen mit MRT-basierten elektrophysiologischen Untersuchungen und Ablationen gesammelt werden. Die Integration der MRT-Technologie in elektrophysiologische Prozeduren verspricht zahlreiche Vorteile. Die Möglichkeit, bei einer MRT-basierten Katheterablation in einem strahlungsfreien Umfeld operieren zu können, stellt einen wichtigen Aspekt dar. Des Weiteren liefert die MRT wichtige prozedurrelevante Informationen, was die Visualisierung von individuellem arrhythmogenem Substrat betrifft. Um den unmittelbaren und langfristigen Ablationserfolg, insbesondere auch im Kontext von komplexen Herzrhythmusstörungen und strukturellen Herzerkrankungen, zukünftig weiter verbessern zu können, ist die direkte und erfolgreiche Integration der MRT-generierten Erkenntnisse in den Ablationsprozess von eminenter Bedeutung. Die Zukunft der MRT-basierten Katheterablation könnte somit insbesondere in der Behandlung von komplexeren Herzrhythmusstörungen liegen, welche personalisierte Therapiepfade erfordern. Diesbezüglich ist die Datenlage jedoch noch äußerst limitiert. Technische Weiterentwicklungen und größere Studien sind unabdingbar, um weitere wichtige Erkenntnisse über die Durchführbarkeit, Sicherheit und Erfolgsrate der MRT-gestützten invasiven elektrophysiologischen Diagnostik und Therapie im Vergleich zu konventionellen Ablationsmethoden gewinnen zu können.

Abstract

Fluoroscopy-based catheter ablation has established itself as a standard procedure for the treatment of patients with cardiac arrhythmias. However, it is subject to certain limitations with regard to the visualization of arrhythmogenic substrate and ablation lesions and is associated with radiation exposure. Within the framework of studies, initial experience with MRI-based, radiation-free electrophysiological examinations and ablations could be gained. The integration of MRI technology into electrophysiological procedures promises numerous advantages. The ability to operate in a radiation-free environment during MRI-based catheter ablation is significant and promising. Furthermore, MRI provides important procedure-relevant information in terms of visualization of individual arrhythmogenic substrate. In order to further improve immediate and long-term ablation success, especially in the context of complex arrhythmias and structural heart disease, the direct and successful integration of MRI-generated findings into the ablation process is of utmost importance. The future of MRI-based catheter ablation could thus lie in particular in the treatment of more complex cardiac arrhythmias, which require personalized therapy paths. In this respect, however, the data situation is still extremely limited. Further technical developments and larger studies are indispensable in order to gain further important insights into the feasibility, safety and success rate of MRI-based invasive electrophysiological diagnostics and therapy in comparison to conventional ablation methods.

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Authors and Affiliations

  1. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    M. Khalaph, D. Guckel, L. Bergau, C. Sohns & P. Sommer

  2. Abteilung für Rhythmologie, Herzzentrum Leipzig, Klinik für Kardiologie, Universität Leipzig, Helios-Stiftungsprofessur, Struempellstr. 39, 04289, Leipzig, Deutschland

    C. Jahnke & I. Paetsch

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  1. M. Khalaph
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  2. D. Guckel
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  3. L. Bergau
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  4. C. Sohns
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  5. C. Jahnke
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  6. I. Paetsch
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Correspondence to M. Khalaph.

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Interessenkonflikt

C. Jahnke, I. Paetsch und P. Sommer erhielten Unterstützung durch einen Forschungs-Grant durch ImriCor. M. Khalaph, D. Guckel, L. Bergau und C. Sohns geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Autoren M. Khalaph und D. Guckel teilen sich die Erstautorenschaft.

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Khalaph, M., Guckel, D., Bergau, L. et al. MRT-basierte Katheterablation. Herzschr Elektrophys 33, 19–25 (2022). https://doi.org/10.1007/s00399-021-00832-w

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