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Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking – experience with 14 cases

  • Cardiac
  • Published:
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Abstract

Objectives

To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access.

Methods

After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging.

Results

Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging.

Conclusions

Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking.

Key points

• Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine.

• Active catheter-tracking allows efficient catheter navigation also in a transseptal approach.

• More MR-conditional tools are needed to facilitate left atrial interventions in humans.

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Abbreviations

AF:

Atrial fibrillation

AV:

Atrioventricular

CMR:

Cardiac Magnetic Resonance

CS:

Coronary sinus

DAS:

Digital amplifier stimulator

ECG:

Surface electrocardiography

EGM:

Intracardiac electrocardiography

EP:

Electrophysiology, electrophysiological

ESC:

European Society of Cardiology

FELASA:

Federation of European Laboratory Animal Science Association

LA:

Left atrium

RA:

Right atrium

SAR:

Specific absorption rate

SSFP:

Steady state free precession

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Acknowledgements

MR imaging conditional catheters were provided by Imricor Medical Systems (Burnsville, MN, USA). The Interventional MRI Suite (iSuite) research prototype was provided by Philips.

The scientific guarantor of this publication is Prof. Matthias Gutberlet – Head of department Radiology.

The authors of this manuscript declare relationships with the following companies:

Matthias Grothoff: Lecturing fees from Siemens and Bracco

Matthias Gutberlet: Lecturing fees from Siemens, Philips, Bayer and Bracco

Bernhard Schnackenburg is an employee of Philips GmbH, Hamburg, Germany.

Steffen Weiss and Sascha Krueger are employees of Philips GmbH Innovative Technologies, Hamburg, Germany.

Philipp Sommer: Lecturing fees and travel grants by St. Jude Medical, Biosense and Imricor. Advisory board member of St. Jude Medical.

Steve Wedan and Thomas Lloyd are employees of Imricor Medical Systems.

Christian Fleiter: nothing to declare

Sebastian Hilbert: nothing to declare

Gerhard Hindricks: research grants from St. Jude Medical and Boston Scientific

Thomas Gaspar: nothing to declare

Christopher Piorkowski: nothing to declare

This study has been supported by an Imricor grant to the University of Leipzig, Germany. Catheter materials for this study were provided by Imricor. The Interventional MRI Suite (iSuite) research prototype was provided by Philips.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Approval from the institutional animal care committee was obtained.

Methodology: prospective, experimental, performed at one institution.

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Author notes

    Authors and Affiliations

    1. Department of Radiology, University of Leipzig - Heart Center, Struempellstr.39, 04289, Leipzig, Germany

      Matthias Grothoff & Matthias Gutberlet

    2. Department of Electrophysiology, University of Leipzig - Heart Center, Struempellstr.39, 04289, Leipzig, Germany

      Gerhard Hindricks, Philipp Sommer & Sebastian Hilbert

    3. Helios Klinikum Berlin-Buch, Department of Orthopaedic Surgery, Schwanebecker Chaussee 50, 13125, Berlin, Germany

      Christian Fleiter

    4. Philips Healthcare, Philipsstr. 14, 20099, Hamburg, Germany

      Bernhard Schnackenburg

    5. Philips Innovative Technologies, Roentgenstr. 24-26, 22335, Hamburg, Germany

      Steffen Weiss & Sascha Krueger

    6. Department of Electrophysiology, University of Dresden – Heart Center, Fetscherstr. 76, 01307, Dresden, Germany

      Christopher Piorkowski & Thomas Gaspar

    7. Imricor Medical Systems, 400 Gateway Blvd., Burnsville, MN, 55337, USA

      Steve Wedan & Thomas Lloyd

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    1. Matthias Grothoff
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    Correspondence to Matthias Grothoff.

    Additional information

    Matthias Grothoff, Matthias Gutberlet, Philipp Sommer and Sebastian Hilbert contributed equally to this work.

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    Grothoff, M., Gutberlet, M., Hindricks, G. et al. Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking – experience with 14 cases. Eur Radiol 27, 1954–1962 (2017). https://doi.org/10.1007/s00330-016-4560-7

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