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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.

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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