Dr. Nassir Marrouche
During the past decade, a rapid evolution of technologies and techniques underlying invasive catheter-based ablation strategies has significantly transformed the management of atrial fibrillation (AF). Perhaps the most notable change in everyday practice has been the use of 3D imaging and energy sources to facilitate catheter ablations. Yet despite considerable scientific and economic investments, outcomes for AF ablation procedurals have not markedly improved. This can be attributed to two factors: 1) the lack of a standard protocol for selecting an appropriate ablation candidate, and 2) the inability to monitor lesion formation in real time to ensure that appropriate ablation therapy was delivered during the procedure. These issues are now being addressed through the integration of tissue structural visualization and treatment into the EP lab. As reported during this year’s ESC annual session, interventional MR and interventional MRI EP lab suites are becoming a reality. Various groups from Europe and the US are reporting feasibility and safety data that apply the real-time MRI concept for delivering atrial and ventricular lesions. For the first time at the ESC, an entire session was dedicated to Atrial Fibrillation and MRI. Dr. Dickfeld presented an elegant review of the progress and challenges in integrating the EP lab into our daily life, including the latest advances from the University of Utah and other institutions regarding real-time visualization of catheter and lesion formation during AF ablation. Dr. Sinha covered new strategies for patient selection highlighting the use of Utah classification system for managing patients with AF, while Drs. Schwitter and Gorcsan discussed use of MRI for image integration, follow-up and procedural outcome prediction. The real advantage of interventional MRI lies in its use in identifying atrial tissue fibrotic changes (defining disease progression) and providing real-time visualization of lesion formation in the EP lab. MRI is becoming an essential part of the life of every physician treating AF.
Interventional cardiovascular magnetic resonance in atrial fibrillation patients - are we on the right path?
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