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Cardiac CT and MR Applications in Electrophysiology

  • Cardiovascular Imaging (K Ordovas, Section Editor)
  • Published:
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Abstract

Purpose of Review

The aims of this article are to discuss the role of cardiac computed tomography (CT) and magnetic resonance (MR) applications in cardiac electrophysiology and to review recent literature including emerging technologies.

Recent Findings

Applications of CT and MR are relevant to electrophysiology procedures in patients with both atrial and ventricular arrhythmias. CT and MR can identify anatomic landmarks and barriers to successful pulmonary vein ablation and left atrial appendage ligation. Further, the excellent tissue characterization provided by cardiac MR allows rapid identification of ventricular ablation targets without the use of ionizing radiation. The use of MR in patients with implanted cardiac devices has been an area of ongoing research as has the emerging technology of real-time interventional cardiac MR to guide electrophysiology procedures.

Summary

Familiarity with these CT/MR techniques and applications will allow radiologists to further assist our colleagues in electrophysiology and to participate in this growing field.

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References

Papers of particular interest, published recently have been highlighted as: • Of importance •• Of major importance

  1. Hendel RC, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006;48(7):1475–97.

    Article  PubMed  Google Scholar 

  2. Lacomis JM, et al. Multi-detector row ct of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. RadioGraphics. 2003;23(suppl_1):S35–48.

    Article  PubMed  Google Scholar 

  3. Cronin P, et al. MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: a how-to guide. Am J Roentgenol. 2004;183(3):767–78.

    Article  Google Scholar 

  4. Saremi F, et al. Bachmann bundle and its arterial supply: imaging with multidetector CT—implications for interatrial conduction abnormalities and arrhythmias. Radiology. 2008;248(2):447–57.

    Article  PubMed  Google Scholar 

  5. Nazarian S, Bluemke DA, Halperin HR. Applications of cardiac magnetic resonance in electrophysiology. Circ Arrhythm Electrophysiol. 2009;2(1):63–71.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Ferreira PF, et al. Cardiovascular magnetic resonance artefacts. J Cardiovasc Magn Reson. 2013;15(1):41.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Falk RH. Atrial fibrillation. N Engl J Med. 2001;344(14):1067–78.

    Article  CAS  PubMed  Google Scholar 

  8. Calkins H, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528–606.

    Article  PubMed  Google Scholar 

  9. Ganesan AN, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(2):e004549.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Nahass GT. Acute radiodermatitis after radiofrequency catheter ablation. J Am Acad Dermatol. 1997;36(5):881–4.

    Article  CAS  PubMed  Google Scholar 

  11. Marom EM, et al. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230(3):824–9.

    Article  PubMed  Google Scholar 

  12. Ghaye B, et al. Percutaneous ablation for atrial fibrillation: the role of cross-sectional imaging. Radiographics. 2003;23(suppl_1):S19–33.

    Article  PubMed  Google Scholar 

  13. Berruezo A, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007;28(7):836–41.

    Article  PubMed  Google Scholar 

  14. Bisbal F, et al. Left atrial sphericity: a new method to assess atrial remodeling. impact on the outcome of atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2013;24(7):752–9.

    Article  PubMed  Google Scholar 

  15. Marrouche NF, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311(5):498–506.

    Article  CAS  PubMed  Google Scholar 

  16. Bisbal F, et al. CMR-guided approach to localize and ablate gaps in repeat AF ablation procedure. JACC Cardiovasc Imaging. 2014;7(7):653–63.

    Article  PubMed  Google Scholar 

  17. Leal S, et al. Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation. Curr Cardiol Rev. 2012;8(1):37–42.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Bartus K, et al. Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: initial clinical experience. J Am Coll Cardiol. 2013;62(2):108–18.

    Article  PubMed  Google Scholar 

  19. Proietti R, et al. Novel nonpharmacologic approaches for stroke prevention in atrial fibrillation: results from clinical trials. Med Devices (Auckl). 2015;8:103–14.

    CAS  Google Scholar 

  20. Suradi HS, Hijazi ZM. Left atrial appendage closure: outcomes and challenges. Neth Heart J. 2017;25(2):143–51.

    Article  CAS  PubMed  Google Scholar 

  21. Patel MB, et al. Safety and effectiveness of compassionate use of LARIAT(R) device for epicardial ligation of anatomically complex left atrial appendages. J Interv Card Electrophysiol. 2015;42(1):11–9.

    Article  PubMed  Google Scholar 

  22. • Lazoura O, et al. A low-dose, dual-phase cardiovascular CT protocol to assess left atrial appendage anatomy and exclude thrombus prior to left atrial intervention. Int J Cardiovasc Imaging. 2016;32(2):347–54. Recent study describing an optimized CT protocol for excluding left atrial appendage thrombus, reducing the impact of contrast mixing.

  23. Bilchick KC, et al. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation. Heart Rhythm. 2016;13(1):12–9.

    Article  PubMed  Google Scholar 

  24. Aliot EM, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm. 2009;6(6):886–933.

    Article  PubMed  Google Scholar 

  25. Kuck KH, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet. 2010;375(9708):31–40.

    Article  PubMed  Google Scholar 

  26. Tao Q, et al. Toward magnetic resonance-guided electroanatomical voltage mapping for catheter ablation of scar-related ventricular tachycardia: a comparison of registration methods. J Cardiovasc Electrophysiol. 2012;23(1):74–80.

    Article  PubMed  Google Scholar 

  27. Wijnmaalen AP, et al. Head-to-head comparison of contrast-enhanced magnetic resonance imaging and electroanatomical voltage mapping to assess post-infarct scar characteristics in patients with ventricular tachycardias: real-time image integration and reversed registration. Eur Heart J. 2011;32(1):104–14.

    Article  PubMed  Google Scholar 

  28. Mavrogeni S, et al. Prediction of ventricular arrhythmias using cardiovascular magnetic resonance. Eur Heart J. 2013;14(6):518–25.

    Google Scholar 

  29. AlJaroudi WA, et al. Role of CMR imaging in risk stratification for sudden cardiac death. JACC Cardiovasc Imaging. 2013;6(3):392–406.

    Article  PubMed  Google Scholar 

  30. •• Andreu D, et al. Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation. Eur Heart J. 2014;35(20):1316–26. This study demonstrates CMR’s excellent ability to successfully identify ventricular ablation targets.

  31. Bisbal F, et al. Use of MRI to guide electrophysiology procedures. Heart. 2014;100(24):1975–84.

    Article  PubMed  Google Scholar 

  32. Cleland JGF, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.

    Article  CAS  PubMed  Google Scholar 

  33. Bax JJ, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44(9):1834–40.

    Article  PubMed  Google Scholar 

  34. Morgan JM, Delgado V. Lead positioning for cardiac resynchronization therapy: techniques and priorities. Europace. 2009;11(Suppl 5):v22–8.

    Article  PubMed  Google Scholar 

  35. Marsan NA, et al. Magnetic resonance imaging and response to cardiac resynchronization therapy: relative merits of left ventricular dyssynchrony and scar tissue. Eur Heart J. 2009;30(19):2360–7.

    Article  PubMed  Google Scholar 

  36. Chalil S, et al. Intraventricular dyssynchrony predicts mortality and morbidity after cardiac resynchronization therapy. J Am Coll Cardiol. 2007;50(3):243–52.

    Article  PubMed  Google Scholar 

  37. Faris OP, Shein MJ. Government viewpoint: U.S. Food & Drug Administration: Pacemakers, ICDs and MRI. Pacing Clin Electrophysiol. 2005;28(4):268–9.

    Article  PubMed  Google Scholar 

  38. • Nazarian S, et al. A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med. 2011;155(7):415–24. Very large series of patients who underwent MR with implanted cardiac devices demonstrating safety and describing device effects.

  39. Mollerus M, et al. Magnetic resonance imaging of pacemakers and implantable cardioverter-defibrillators without specific absorption rate restrictions. Europace. 2010;12(7):947–51.

    Article  PubMed  Google Scholar 

  40. •• Mesubi O, et al. Impact of ICD artifact burden on late gadolinium enhancement cardiac MR imaging in patients undergoing ventricular tachycardia ablation. Pacing Clin Electrophysiol. 2014;37(10):1274–83. This study examined the most frequent locations affected by artifact from implanted cardiac devices when performing delayed enhancement imaging.

  41. Rashid S, et al. Improved late gadolinium enhancement mr imaging for patients with implanted cardiac devices. Radiology. 2014;270(1):269–74.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Shroff GS, et al. CT imaging of complications of catheter ablation for atrial fibrillation. Clin Radiol. 2014;69(1):96–102.

    Article  CAS  PubMed  Google Scholar 

  43. Packer DL, et al. Clinical presentation, investigation, and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation. 2005;111(5):546–54.

    Article  PubMed  Google Scholar 

  44. Holmes DR Jr, Monahan KH, Packer D. Pulmonary vein stenosis complicating ablation for atrial fibrillation: clinical spectrum and interventional considerations. JACC Cardiovasc Interv. 2009;2(4):267–76.

    Article  PubMed  Google Scholar 

  45. Peichl P, et al. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol. 2014;7(4):684–90.

    Article  PubMed  Google Scholar 

  46. Katz DF, et al. Safety of ventricular tachycardia ablation in clinical practice: findings from 9699 hospital discharge records. Circ Arrhythm Electrophysiol. 2015;8(2):362–70.

    Article  PubMed  Google Scholar 

  47. Bhagirath P, et al. Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation. Circ Arrhythm Electrophysiol. 2015;8(1):203–11.

    Article  PubMed  Google Scholar 

  48. Hilbert S, et al. Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series. Europace. 2016;18(4):572–7.

    Article  PubMed  Google Scholar 

  49. Grothoff M, et al. MR imaging-guided electrophysiological ablation studies in humans with passive catheter tracking: initial results. Radiology. 2014;271(3):695–702.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue M391, San Francisco, CA, 94143, USA

    Kimberly Kallianos, Purvi Parwani & Karen G. Ordovas

Authors
  1. Kimberly Kallianos
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  2. Purvi Parwani
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  3. Karen G. Ordovas
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Corresponding author

Correspondence to Kimberly Kallianos.

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Conflict of interest

Kimberly Kallianos and Purvi Parwani each declare no potential conflicts of interest. Karen G. Ordovas is on the advisory board for Arterys and reports a research grant from GE Healthcare. Dr. Ordovas is a section editor for Current Radiology Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical collection on Cardiovascular Imaging.

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Kallianos, K., Parwani, P. & Ordovas, K.G. Cardiac CT and MR Applications in Electrophysiology. Curr Radiol Rep 5, 63 (2017). https://doi.org/10.1007/s40134-017-0257-1

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  • DOI: https://doi.org/10.1007/s40134-017-0257-1

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