Tampakis K, Pastromas S, Sykiotis A, Kampanarou S, Kourgiannidis G, Pyrpiri C, Bousoula M, Rozakis D, Andrikopoulos G. Real-time cardiovascular magnetic resonance-guided radiofrequency ablation: A comprehensive review. World J Cardiol 2023; 15(9): 415-426 [PMID: 37900261 DOI: 10.4330/wjc.v15.i9.415]
Corresponding Author of This Article
Konstantinos Tampakis, MD, MSc, Consultant Physician-Scientist, Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, 107, Mesogion Ave, Athens 11526, Greece. kostastampakis@hotmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2023; 15(9): 415-426 Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.415
Real-time cardiovascular magnetic resonance-guided radiofrequency ablation: A comprehensive review
Konstantinos Tampakis, Sokratis Pastromas, Alexandros Sykiotis, Stamatina Kampanarou, Georgios Kourgiannidis, Chrysa Pyrpiri, Maria Bousoula, Dimitrios Rozakis, George Andrikopoulos
Konstantinos Tampakis, Sokratis Pastromas, Alexandros Sykiotis, Georgios Kourgiannidis, George Andrikopoulos, Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
Stamatina Kampanarou, Chrysa Pyrpiri, Department of Radiology, Henry Dunant Hospital Center, Athens 11526, Greece
Maria Bousoula, Dimitrios Rozakis, Department of Anesthesiology, Henry Dunant Hospital Center, Athens 11526, Greece
Author contributions: Tampakis K, Andrikopoulos G and Kampanarou S wrote and revised the manuscript; Pastromas S, Sykiotis A, Pyrpiri C, Bousoula M, Rozakis D and Kourgiannidis G contributed to the collection of data; All authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors have no conflicts to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Tampakis, MD, MSc, Consultant Physician-Scientist, Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, 107, Mesogion Ave, Athens 11526, Greece. kostastampakis@hotmail.com
Received: April 27, 2023 Peer-review started: April 27, 2023 First decision: July 19, 2023 Revised: August 10, 2023 Accepted: August 31, 2023 Article in press: August 31, 2023 Published online: September 26, 2023 Processing time: 146 Days and 12 Hours
Abstract
Cardiac magnetic resonance (CMR) imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Over the last decade, technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed. However, performing procedures outside the conventional fluoroscopic laboratory posed technical, practical and safety concerns. The development of magnetic resonance imaging compatible ablation systems, the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors. The first human reports, in order to establish a procedural workflow, have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation. Potential expansion to other more complex arrhythmias, especially ventricular tachycardia and atrial fibrillation, would be of essential impact, taking into consideration the widespread use of substrate-based strategies. Importantly, all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.
Core Tip: Technologies and platforms for performing electrophysiology procedures in a cardiac magnetic resonance (CMR) environment have been developed and several human studies have demonstrated that CMR-guided catheter ablation is feasible for typical atrial flutter ablation. Expansion to other more complex arrhythmias, especially ventricular tachycardia and atrial fibrillation, would be of essential impact, taking into consideration the widespread use of substrate-based strategies. Importantly, several limitations need to be solved before application of CMR-guided ablation in a broad clinical setting. This article reviews the clinical implementation of real-time CMR-guided catheter ablation and discusses the potential benefits, challenges and future perspectives of this approach in the treatment of cardiac arrhythmias.
