Halperin Henry R, Kolandaivelu Aravindan
Johns Hopkins University, School of Medicine, Division of Cardiology, Baltimore, MD 21205, USA.
Rambam Maimonides Med J. 2010 Oct 31;1(2):e0015. doi: 10.5041/RMMJ.10015. Print 2010 Oct.
Catheter ablation is a first-line treatment for many cardiac arrhythmias and is generally performed under X-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with sub-optimal success rates and prolonged radiation exposure. Pre-procedure 3-D magnetic resonance imaging (MRI) has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of MRI compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure MRI is now being applied to assess ablation lesion location and permanence with the goal of identifying factors leading to procedure success and failure. In the future, intra-procedure real-time MRI, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade MRI-compatible electrophysiology devices is required to transition intra-procedure MRI from preclinical studies to more routine use in patients.
导管消融术是许多心律失常的一线治疗方法，通常在X线透视引导下进行。然而，目前用于消融心房颤动和室性心动过速等复杂心律失常的技术，其成功率欠佳且辐射暴露时间长。术前三维磁共振成像（MRI）有助于更好地理解复杂心律失常的解剖学基础，并正被用于消融手术的规划和引导。与其他成像方式相比，MRI的一个特殊优势在于能够可视化消融灶。术后MRI现正被用于评估消融灶的位置和持久性，目的是确定导致手术成功和失败的因素。未来，术中实时MRI，连同对复杂三维致心律失常解剖结构成像以及对病变形成不完全区域进行额外消融的能力，可能使即使是复杂心律失常也能在不暴露于电离辐射的情况下得到更成功的治疗。要将术中MRI从临床前研究过渡到在患者中更常规地使用，需要开发临床级MRI兼容的电生理设备。
