Götte Marco J W, Hopman Luuk H G A, Bhagirath Pranav, Kemme Michiel J B, Nelissen Jules L, Lindborg Katherine, Krafft Axel J, Sprengers Marieke E S, Chamuleau Steven A J, Allaart Cornelis P
Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
JAMA Cardiol. 2025 Sep 17. doi: 10.1001/jamacardio.2025.3000.
Catheter ablation is a cornerstone therapy for symptomatic ventricular arrhythmias, yet current techniques rely on fluoroscopy and electroanatomic mapping, which provide limited soft-tissue detail and expose patients and staff to ionizing radiation. Real-time magnetic resonance (MR)-guided ablation may overcome these limitations by enabling direct visualization of cardiac anatomy, substrate, and lesion formation, all within a radiation-free environment.
To demonstrate the technical feasibility and safety of the first-in-human real-time MR-guided radiofrequency ventricular ablation procedure.
DESIGN, SETTING, AND PARTICIPANT: This was a prospective, worldwide-first roll-in case from the ongoing VISABL-VT nonrandomized clinical trial assessing MR-guided radiofrequency ablation of ventricular tachycardia. The procedure and analysis were performed in April 2025 at an academic tertiary care center equipped with a standard 1.5-T MR imaging (MRI) suite and dedicated MR-compatible electrophysiology platform, MR-compatible 12-lead electrocardiographic monitoring and recording system, MR-conditional defibrillator, and real-time catheter tracking integrated with the MRI scanner for synchronized imaging and ablation. The patient was a 73-year-old man with symptomatic, drug-refractory outflow tract premature ventricular complexes (PVCs).
The ablation was performed under general anesthesia inside the MRI scanner. Intraprocedurally acquired noncontrast 3-dimensional MR angiographic imaging was used to create an anatomical roadmap for the procedure. Real-time catheter tracking and activation mapping were performed using actively tracked diagnostic and ablation catheters. Mapping identified earliest activation first in the posterior septal right ventricular outflow tract, where ablation transiently suppressed PVCs. Ectopy recurred but was ultimately resolved by ablation performed via a retrograde aortic approach in the left coronary cusp. Lesion formation was confirmed via postprocedural MRI.
Suppression of PVCs and presence or absence of procedural complications.
The procedure was performed under real-time MRI guidance without complications. PVCs were completely suppressed, with no recurrence during 30-minute observation or at 2-month follow-up.
This first-in-human case demonstrates that ventricular ablation can be safely and effectively performed entirely under real-time MR guidance. Further evidence from the VISABL-VT trial will clarify clinical utility and long-term outcomes.
导管消融是症状性室性心律失常的基石性治疗方法，但目前的技术依赖于荧光透视和电解剖标测，其提供的软组织细节有限，且会使患者和工作人员暴露于电离辐射中。实时磁共振（MR）引导下的消融可能通过在无辐射环境中直接可视化心脏解剖结构、基质和病变形成来克服这些局限性。
证明首例人体实时MR引导下射频室性消融手术的技术可行性和安全性。
设计、地点和参与者：这是一项来自正在进行的VISABL-VT非随机临床试验的前瞻性、全球首例纳入病例，该试验评估MR引导下室性心动过速的射频消融。手术和分析于2025年4月在一家配备标准1.5-T磁共振成像（MRI）设备和专用MR兼容电生理平台、MR兼容12导联心电图监测和记录系统、MR条件除颤器以及与MRI扫描仪集成的实时导管跟踪以实现同步成像和消融的学术三级护理中心进行。患者为一名73岁男性，有症状性、药物难治性流出道室性早搏（PVC）。
在MRI扫描仪内全身麻醉下进行消融。术中获取的非增强三维MR血管造影成像用于创建手术的解剖路线图。使用主动跟踪的诊断和消融导管进行实时导管跟踪和激动标测。标测首先在右心室流出道后间隔最早发现激动，在此处消融短暂抑制了PVC。异位心律复发，但最终通过在左冠状动脉窦采用逆行主动脉入路进行消融得以解决。术后MRI证实了病变形成。
PVC的抑制情况以及手术并发症的有无。
手术在实时MRI引导下进行，无并发症。PVC完全被抑制，在30分钟观察期内或2个月随访时均无复发。
首例人体病例表明，室性消融可以在实时MR引导下完全安全有效地进行。VISABL-VT试验的进一步证据将阐明其临床实用性和长期结局。
