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[心脏磁共振诊断在心律失常患者中的益处:从风险分层到介入治疗]

[Benefits of cardiac magnetic resonance diagnostics in patients with heart rhythm disorders : From risk stratification to interventional procedures].

作者信息

Oebel S, Jahnke C, Hindricks G, Paetsch I

机构信息

Abteilung Rhythmologie, Universitätsklinik für Kardiologie - HELIOS-Stiftungsprofessur, Strümpellstr. 39, 04289, Leipzig, Deutschland.

出版信息

Herz. 2022 Apr;47(2):110-117. doi: 10.1007/s00059-022-05105-x. Epub 2022 Mar 11.

DOI:10.1007/s00059-022-05105-x
PMID:35277724
Abstract

Cardiac magnetic resonance imaging (cMRI) now rates among the established diagnostic procedures for the clarification of cardiac disease patterns. In modern clinical electrophysiology, apart from providing basic cardiac diagnostics of patients prior to interventional procedures, the imaging method enables the three-dimensional reconstruction of cardiac target structures of the planned ablation procedure, which can significantly improve the safety and efficacy of the intervention. Furthermore, cMRI has a high significance with respect to risk stratification during implantable cardioverter defibrillator (ICD) evaluation. In addition to an exact determination of ventricular function, its capability for detailed tissue characterization enables the visualization and quantification of fibrotic lesions and scar tissue as potential arrhythmogenic triggers. This anatomic assignment also enables an increased accuracy of the ablation of substrate-based arrhythmia. In comparison to this the interventional cMRI as a direct interface between cMRI and invasive electrophysiology represents a comparably new field of application. Initial clinical experiences in the field of ablation of typical atrial fibrillation could not only confirm the feasibility of the concept but also enabled recognition of the clear advantages of an imaging-guided electrophysiological procedure.

摘要

心脏磁共振成像(cMRI)目前已成为明确心脏疾病模式的既定诊断方法之一。在现代临床电生理学中,除了在介入手术前为患者提供基本的心脏诊断外,这种成像方法还能对计划进行的消融手术的心脏目标结构进行三维重建,这可显著提高干预的安全性和有效性。此外,cMRI在植入式心脏复律除颤器(ICD)评估期间的风险分层方面具有重要意义。除了能精确测定心室功能外,其详细的组织特征分析能力还能使纤维化病变和瘢痕组织作为潜在的致心律失常触发因素得以可视化和量化。这种解剖定位还能提高基于基质的心律失常消融的准确性。相比之下,介入性cMRI作为cMRI与侵入性电生理学之间的直接接口,是一个相对较新的应用领域。典型心房颤动消融领域的初步临床经验不仅证实了该概念的可行性,还使人们认识到成像引导电生理手术的明显优势。

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本文引用的文献

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CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry.心脏磁共振在非缺血性扩张型心肌病患者中预防植入式心脏复律除颤器治疗的国际注册研究。
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Efficacy of LGE-MRI-guided fibrosis ablation versus conventional catheter ablation of atrial fibrillation: The DECAAF II trial: Study design.LGE-MRI 引导的纤维化消融与常规导管消融治疗心房颤动的疗效:DECAAF II 试验:研究设计。
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2020年欧洲心脏病学会(ESC)与欧洲心胸外科学会(EACTS)合作制定的心房颤动诊断和管理指南:欧洲心脏病学会(ESC)心房颤动诊断和管理特别工作组,由ESC欧洲心律协会(EHRA)特别贡献制定。
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Cardiac Magnetic Resonance-Guided Ventricular Tachycardia Substrate Ablation.心脏磁共振引导下心室性心动过速基质消融。
JACC Clin Electrophysiol. 2020 Apr;6(4):436-447. doi: 10.1016/j.jacep.2019.11.004. Epub 2020 Feb 26.
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Combined single-session cardiovascular magnetic resonance: stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation patients with chest pain syndromes prior to catheter ablation.联合单次心血管磁共振:负荷灌注和三维肺动脉造影在导管消融前对胸痛综合征的心房颤动患者进行分层。
Europace. 2019 Dec 1;21(12):1809-1816. doi: 10.1093/europace/euz248.
7
Clinical workflow and applicability of electrophysiological cardiovascular magnetic resonance-guided radiofrequency ablation of isthmus-dependent atrial flutter.电生理心血管磁共振引导的峡部依赖性房扑射频消融的临床工作流程和适用性。
Eur Heart J Cardiovasc Imaging. 2019 Feb 1;20(2):147-156. doi: 10.1093/ehjci/jey143.
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Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation for Atrial Fibrillation: Single-Center Experience in Catheter Interventional Treatment.房颤射频消融术后获得性肺静脉狭窄:导管介入治疗的单中心经验。
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Characteristics of the ablation lesions in cardiac magnetic resonance imaging after radiofrequency ablation of ventricular arrhythmias in relation to the procedural success.射频消融治疗室性心律失常后心脏磁共振成像消融灶特征与手术成功率的关系。
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Development, Preclinical Validation, and Clinical Translation of a Cardiac Magnetic Resonance - Electrophysiology System With Active Catheter Tracking for Ablation of Cardiac Arrhythmia.心脏磁共振-电生理系统的研发、临床前验证及临床转化,该系统带有主动导管跟踪功能,用于心律失常的消融治疗。
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