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Image-Guided Cardiac Electrophysiology Procedures Focusing on MRI Guidance

Image-Guided Cardiac EP Procedures

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Intraoperative Imaging and Image-Guided Therapy

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Abstract

Cardiac electrophysiology (EP) is a rapidly growing field, a result of the large and growing number of patients suffering from atrial fibrillation (AF) and ventricular tachycardia (VT). The success rate of ablation in patients with paroxysmal and persistent AF is approximately 70 % and 50 %, respectively; while in those with scar-related ventricular tachycardia, the success rate is approximately 50 %. As a result, there is a need for improved procedural techniques and a deeper understanding of recurrences in failed procedures. The field of EP has generated considerable industrial interest, so that the field is highly advanced technologically and uses tools that are not frequently seen in other surgical or interventional fields.

MR imaging offers unique solutions to several current EP procedural limitations, by providing robust multi-contrast imaging of the cardiac chambers’ lumen and wall. As a result, cardiac-MRI imaging has grown in prominence as a pre- and post-procedural EP tool. We cover the growth of MRI in these applications and then discuss the more complex issues entailed in performance of intra-procedural MRI, which may greatly improve EP outcomes and is a topic of extensive present research. We discuss the requirements of intra-procedural MRI and demonstrate one system built to address these needs.

We discuss applications in which preclinical and clinical results have already been obtained using intra-procedural MRI. We also present emerging MRI sequences and clinical applications which may further extend the utility of MRI-guided EP.

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Acknowledgements

We gratefully acknowledge funding from AHA SDG 10S0G2610139, NCRR/NCI 1P41RR019703-01A2, NHLBI R43 HL110427-01, and NHLBI K23 HL68064. We would also like to thank all of those who kindly provided us with images.

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Authors and Affiliations

  1. National Center for Image Guided Therapy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ehud J. Schmidt PhD

  2. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Charles L. Dumoulin PhD

  3. Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA

    Stephan A. Danik MD

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  1. Ehud J. Schmidt PhD
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  2. Charles L. Dumoulin PhD
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  3. Stephan A. Danik MD
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Correspondence to Ehud J. Schmidt PhD .

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Editors and Affiliations

  1. National Center for Image Guided Therapy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Ferenc A. Jolesz

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Schmidt, E.J., Dumoulin, C.L., Danik, S.A. (2014). Image-Guided Cardiac Electrophysiology Procedures Focusing on MRI Guidance. In: Jolesz, F. (eds) Intraoperative Imaging and Image-Guided Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7657-3_54

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  • DOI: https://doi.org/10.1007/978-1-4614-7657-3_54

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