Citation : Charlotte Eitel, Christopher Piorkowski, Thomas Gaspar, Philipp Sommer, Gerhard Hindricks
The most promising technology that might facilitate completely non-fluoroscopic cardiovascular interventions in the future is real-time magnetic resonance imaging (MRI). Several characteristics of MRI make this imaging technology particularly attractive to guide cardiovascular interventions. Benefits relate to (1) the fluoroscopy-free environment, (2) substrate analysis, (3) combination of three-dimensional anatomical and functional information and (4) lesion visualization. The safety and feasibility of real-time MRI guided electrophysiology studies and first ablation procedures in humans have been described recently. Nevertheless these experiences are limited to few centers and widespread application is still limited. This article will discuss advantages, challenges and limitations of real-time MRI procedures.
Fluoroscopy is still the standard technique for guidance of cardiovascular interventions due to fast and instantaneous generation of twodimensional projections of the cardiac contour and any fluoroscopically visible device. However, it is associated with significant radiation exposure to the patient and the operator and information on the underlying three-dimensional anatomy is limited. With a growing amount of complex cardiovascular procedures, radiation exposure with potential detrimental effects increases for both the patient and the operator, who is often exposed over many years. Therefore efforts are made to reduce radiation exposure on the one hand and to enhance understanding of the underlying anatomical substrate with the aim of improving outcomes and reducing complications on the other hand.
The most promising technology that might facilitate completely non-fluoroscopic cardiovascular interventions in the future is real-time magnetic resonance imaging (MRI). Several characteristics of MRI make this imaging technology particularly attractive to guide cardiovascular interventions. Benefits relate to (1) the fluoroscopy-free environment, (2) substrate analysis, (3) combination of three-dimensional anatomical and functional information and (4) lesion visualization. The safety and feasibility of real-time MRI guided electrophysiology studies and first ablation procedures in humans have been described recently. Nevertheless these experiences are limited to few centers and widespread application is still limited. This article will discuss advantages, challenges and limitations of real-time MRI procedures.
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