Interventional Applications

1351235 - MRI-guided Conventional Catheter Ablation of Isthmus-dependent Atrial Flutter Using Active Catheter Imaging

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

SU

Stefan Ulbrich, MD

MD
Heart Center University Dresden
Dresden, Sachsen, Germany

Primary Author(s)

SU

Stefan Ulbrich, MD

MD
Heart Center University Dresden
Dresden, Sachsen, Germany

Co-Author(s)

YH

Yan Huo, MD, PhD

MD, PhD
Heart Center University Dresden, Germany
Jakub Tomala, MD

MD
Heart Center University Dresden
Dresden, Sachsen, Germany
MW

Michael Wagner, MD, PhD

MD, PhD
Heart Center University Dresden, Germany
UR

Utz Richter, MD

MD
Heart Center University Dresden, Germany
LP

Liying Pu, MD

MD
Heart Center University Dresden, Germany
JM

Julia Mayer, MD

MD
Heart Center University Dresden, Germany
AZ

Angela Zedda, MD

MD
Heart Center University Dresden, Germany
AK

Axel J. Krafft, PhD

PhD
Siemens Healthcare GmbH
Erlangen, Bayern, Germany
KL

Katherine Lindborg, PhD

PhD
Imricor Medical Systems, Inc, United States
CP

Christopher Piorkowski, MD

MD
Heart Center University Dresden, Germany
TG

Thomas Gaspar, MD

MD
Heart Center University Dresden, Germany

Background: Interventional cardiac magnetic resonance (iCMR) has been established as a radiation-free alternative comparing to standard fluoroscopy-guided catheter ablation due to cavotricuspid isthmus (CTI)-dependent atrial flutter to image anatomy, structural alterations, and further catheter guidance. The purpose of this analysis was to explore the safety, feasibility, and efficacy of CTI ablations performed completely in the iCMR suite using active catheter imaging.

Methods: Consecutive patients underwent iCMR-guided catheter ablation due to CTI-dependent atrial flutter. Procedures were performed in a 1.5T MRI with MR-conditional ablation catheters. Catheter guidance was achieved using active catheter imaging via integrated MR receive tip coils (figure). Acute success, periprocedural complications, and short-term follow-up were collected for further analysis.

Results: All patients (n=15; 73% male; median age 70 years, IQR 67-82) achieved acute procedure success without any complication. The median procedure time was 43 min (IQR 33-58) with a median RF delivery time of 18 min (IQR 12-26). Post-procedure lesion visualization scanning was completed in a median of 32 min (IQR 10-42). None of the patients with a 6-month follow-up had atrial flutter recurrence.

Conclusion: In the iCMR suite, CTI-dependent atrial flutter ablation could be achieved safely using active catheter imaging without any complication. It further allows detailed anatomic visualization of the CTI, intra-procedural lesion visualization, and exclusion of pericardial effusion.