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MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions.
IEEE Trans Biomed Eng. 2022 08; 69(8):2657-2666.IT

Abstract

OBJECTIVE

Radiofrequency (RF) energy delivered to cardiac tissue produces a core ablation lesion with surrounding edema, the latter of which has been implicated in acute procedural failure of Ventricular Tachycardia (VT) ablation and late arrhythmia recurrence. This study sought to investigate the electrophysiological characteristics of acute RF lesions in the left ventricle (LV) visualized with native-contrast Magnetic Resonance Imaging (MRI).

METHODS

An MR-guided electrophysiology system was used to deliver RF ablation in the LV of 8 swine (9 RF lesions in total), then perform MRI and electroanatomic mapping. The permanent RF lesions and transient edema were delineated via native-contrast MRI segmentation of T1-weighted images and T2 maps respectively. Bipolar voltage measurements were matched with image characteristics of pixels adjacent to the catheter tip. Native-contrast MR visualization was verified with 3D late gadolinium enhanced MRI and histology.

RESULTS

The T2-derived edema was significantly larger than the T1-derived RF lesion (2.1 ±1.5 mL compared to 0.58 ±0.34 mL; p=0.01). Bipolar voltage was significantly reduced in the presence of RF lesion core (p 0.05) and edema (p 0.05), with similar trends suggesting that both the permanent lesion and transient edema contributed to the region of reduced voltage. While bipolar voltage was significantly decreased where RF lesions are present (p 0.05), voltage did not change significantly with lesion transmurality (p 0.05).

CONCLUSION

Permanent RF lesions and transient edema are distinct in native-contrast MR images, but not differentiable using bipolar voltage.

SIGNIFICANCE

Intraprocedural native-contrast MRI may provide valuable lesion assessment in MR-guided ablation, whose clinical application is now feasible.

Links

Publisher Full Text (DOI)

Authors

Krahn PRP
No affiliation info available
Biswas L
No affiliation info available
Ferguson S
No affiliation info available
Ramanan V
No affiliation info available
Barry J
No affiliation info available
Singh SM
No affiliation info available
Pop M
No affiliation info available
Wright GA
No affiliation info available

MeSH

AnimalsCatheter AblationHeartHeart VentriclesMagnetic Resonance ImagingRadiofrequency AblationSwine

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35171765

Citation

Krahn, Philippa R P., et al. "MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions." IEEE Transactions On Bio-medical Engineering, vol. 69, no. 8, 2022, pp. 2657-2666.
Krahn PRP, Biswas L, Ferguson S, et al. MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. IEEE Trans Biomed Eng. 2022;69(8):2657-2666.
Krahn, P. R. P., Biswas, L., Ferguson, S., Ramanan, V., Barry, J., Singh, S. M., Pop, M., & Wright, G. A. (2022). MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. IEEE Transactions On Bio-medical Engineering, 69(8), 2657-2666. https://doi.org/10.1109/TBME.2022.3152145
Krahn PRP, et al. MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. IEEE Trans Biomed Eng. 2022;69(8):2657-2666. PubMed PMID: 35171765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - MRI-Guided Cardiac RF Ablation for Comparing MRI Characteristics of Acute Lesions and Associated Electrophysiologic Voltage Reductions. AU - Krahn,Philippa R P, AU - Biswas,Labonny, AU - Ferguson,Sebastian, AU - Ramanan,Venkat, AU - Barry,Jennifer, AU - Singh,Sheldon M, AU - Pop,Mihaela, AU - Wright,Graham A, Y1 - 2022/07/18/ PY - 2022/2/17/pubmed PY - 2022/7/22/medline PY - 2022/2/16/entrez SP - 2657 EP - 2666 JF - IEEE transactions on bio-medical engineering JO - IEEE Trans Biomed Eng VL - 69 IS - 8 N2 - OBJECTIVE: Radiofrequency (RF) energy delivered to cardiac tissue produces a core ablation lesion with surrounding edema, the latter of which has been implicated in acute procedural failure of Ventricular Tachycardia (VT) ablation and late arrhythmia recurrence. This study sought to investigate the electrophysiological characteristics of acute RF lesions in the left ventricle (LV) visualized with native-contrast Magnetic Resonance Imaging (MRI). METHODS: An MR-guided electrophysiology system was used to deliver RF ablation in the LV of 8 swine (9 RF lesions in total), then perform MRI and electroanatomic mapping. The permanent RF lesions and transient edema were delineated via native-contrast MRI segmentation of T1-weighted images and T2 maps respectively. Bipolar voltage measurements were matched with image characteristics of pixels adjacent to the catheter tip. Native-contrast MR visualization was verified with 3D late gadolinium enhanced MRI and histology. RESULTS: The T2-derived edema was significantly larger than the T1-derived RF lesion (2.1 ±1.5 mL compared to 0.58 ±0.34 mL; p=0.01). Bipolar voltage was significantly reduced in the presence of RF lesion core (p 0.05) and edema (p 0.05), with similar trends suggesting that both the permanent lesion and transient edema contributed to the region of reduced voltage. While bipolar voltage was significantly decreased where RF lesions are present (p 0.05), voltage did not change significantly with lesion transmurality (p 0.05). CONCLUSION: Permanent RF lesions and transient edema are distinct in native-contrast MR images, but not differentiable using bipolar voltage. SIGNIFICANCE: Intraprocedural native-contrast MRI may provide valuable lesion assessment in MR-guided ablation, whose clinical application is now feasible. SN - 1558-2531 UR - https://www.unboundmedicine.com/medline/citation/35171765/MRI_Guided_Cardiac_RF_Ablation_for_Comparing_MRI_Characteristics_of_Acute_Lesions_and_Associated_Electrophysiologic_Voltage_Reductions_ DB - PRIME DP - Unbound Medicine ER -