12 research outputs found
Cardiovascular magnetic resonance guided electrophysiology studies
Catheter ablation is a first line treatment for many cardiac arrhythmias and is generally performed under x-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with suboptimal success rates and prolonged radiation exposure. Pre-procedure 3D CMR has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of CMR compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure CMR is now being applied to assess ablation lesion location and permanence with the goal of indentifying factors leading to procedure success and failure. In the future, intra-procedure real-time CMR, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade CMR compatible electrophysiology devices is required to transition intra-procedure CMR from pre-clinical studies to more routine use in patients
Comparison of methods for the analysis of Phase Sensitivity Inversion Recovery Images in the Assessment of Myocardial Infarction
MĂ©todos estadĂsticos para anĂĄlisis de MRI PSI
MRI-Guided Electrophysiology Intervention
Catheter ablation is a first-line treatment for many cardiac arrhythmias and is generally performed under X-ray fluoroscopy guidance. However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with sub-optimal success rates and prolonged radiation exposure. Pre-procedure 3-D magnetic resonance imaging (MRI) has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. A particular strength of MRI compared to other imaging modalities is the ability to visualize ablation lesions. Post-procedure MRI is now being applied to assess ablation lesion location and permanence with the goal of identifying factors leading to procedure success and failure. In the future, intra-procedure real-time MRI, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. Development of clinical grade MRI-compatible electrophysiology devices is required to transition intra-procedure MRI from preclinical studies to more routine use in patients
Correction for the Article âMRI-Guided Electrophysiology Interventionâ by Henry R. Halperin and Aravindan Kolandaivelu
[Extract]
In the following paper: Halperin HR, Kolandaivelu A. MRI-Guided Electrophysiology Intervention. Rambam Maimonides Med J, 2010 October;1(2): e00015, it was noted that the Acknowledgement regarding the source of the text was not published. The following Acknowledgement has been added: ..
Interventional cardiovascular magnetic resonance: state-of-the-art
Abstract Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications
Growth Differentiation Factorâ15 Predicts Mortality and Heart Failure Exacerbation But Not Ventricular Arrhythmias in Patients With Cardiomyopathy
Background Heart failure (HF) has been increasing in prevalence, and a need exists for biomarkers with improved predictive and prognostic ability. GDFâ15 (growth differentiation factorâ15) is a novel biomarker associated with HF mortality, but no serial studies of GDFâ15 have been conducted. This study aimed to investigate the association between GDFâ15 levels over time and the occurrence of ventricular arrhythmias, HF hospitalizations, and allâcause mortality. Methods and Results We used a retrospective caseâcontrol design to analyze 148 patients with ischemic and nonischemic cardiomyopathies and primary prevention implantable cardioverterâdefibrillator (ICD) from the PROSeâICD (Prospective Observational Study of the ICD in Sudden Cardiac Death Prevention) cohort. Patients had blood drawn every 6âmonths and after each appropriate ICD therapy and were followed for a median followâup of 4.6âyears, between 2005 to 2019. We compared serum GDFâ15 levels within ±90âdays of an event among those with a ventricular tachycardia/fibrillation event requiring ICD therapies and those hospitalized for decompensated HF. A comparator/control group comprised patients with GDFâ15 levels available during 2âyear followâup periods without events. Median followâup was 4.6âyears in the 148 patients studied (mean age 58±12, 27% women). The HF cohort had greater median GDFâ15 values within 90âdays (1797âpg/mL) and 30âdays (2039âpg/mL) compared with the control group (1062âpg/mL, both P<0.0001). No difference was found between the ventricular tachycardia/fibrillation subgroup within 90âdays (1173âpg/mL, P=0.60) or 30âdays (1173âpg/mL, P=0.78) and the control group. GDFâ15 was also significantly predictive of mortality (hazard ratio, 3.17 [95% CI, 2.33â4.30]). Conclusions GDFâ15 levels are associated with HF hospitalization and mortality but not ventricular arrhythmic events
Chest Pain in a Young Basketball Player
A 32-year-old man was elbowed in the chest while fighting for a rebound in a recreational basketball game. He fell to the ground and his chest ached from the blow. Four days later he developed more severe chest pressure with dyspnea and came to the hospital. His chest wall was tender and his pulse slow, but the remainder of his physical examination was normal. Electrocardiogram showed sinus bradycardia, first-degree atrioventricular (AV) block, and occasional isorhythmic AV dissociation, but no ischemic ST-T changes. Cardiac troponin I rose to 1.74 ng/mL (normal <0.50). The patient therefore underwent coronary angiography, showing spiral dissection of the right coronary artery with extensive thrombus filling the distal portion of the vessel. Stenting was unsuccessful in restoring flow. This case highlights the potential dangers of blunt chest trauma in recreational sports and shows how angiography can distinguish myocardial contusion from coronary artery dissection