Electrophysiological Cardiovascular Magnetic Resonance (EP-CMR)-Guided Interventional Procedures: Challenges and Opportunities.

Purpose Of Review: Cardiovascular magnetic resonance (CMR) imaging excels in providing detailed three-dimensional anatomical information together with excellent soft tissue contrast and has already become a valuable tool for diagnostic evaluation, electrophysiological procedure (EP) planning, and therapeutical stratification of atrial or ventricular rhythm disorders. CMR-based identification of ablation targets may significantly impact existing concepts of interventional electrophysiology. In order to exploit the inherent advantages of CMR imaging to the fullest, CMR-guided ablation procedures (EP-CMR) are justly considered the ultimate goal.

Electrophysiological cardiovascular MR: procedure-ready mesh model generation for interventional guidance based on non-selective excitation compressed sensing whole heart imaging.

Fully CMR-guided electrophysiological interventions (EP-CMR) have recently been introduced but data on the optimal CMR imaging protocol are scarce. This study determined the clinical utility of 3D non-selective whole heart steady-state free precession imaging using compressed SENSE (nsWHcs) for automatic segmentation of cardiac cavities as the basis for targeted catheter navigation during EP-CMR cavo-tricuspid isthmus ablation. Fourty-two consecutive patients with isthmus-dependent right atrial flutter underwent EP-CMR radiofrequency ablations.

Cardiovascular magnetic resonance pulmonary perfusion for functional assessment of pulmonary vein stenosis.

Background: Cardiovascular magnetic resonance (CMR) imaging allows to combine pulmonary perfusion measurements and pulmonary venous angiography during a single-session examination with both imaging modules representing the basis for accurate diagnosis and therapeutic stratification of pulmonary vein (PV) stenosis. The present study investigated the clinical utility of dynamic pulmonary perfusion imaging integrated into a comprehensive CMR protocol for the evaluation of patients with suspected PV stenosis.

Methods: 162 patients with clinically suspected PV stenosis after catheter ablation of atrial fibrillation underwent a combined single-session CMR examination (cardiac cine imaging, dynamic pulmonary perfusion, and three-dimensional PV angiography).

Cardiovascular magnetic resonance pulmonary perfusion for guidance of interventional treatment of pulmonary vein stenosis.

Background: Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.

Methods: CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up.

[Benefits of cardiac magnetic resonance diagnostics in patients with heart rhythm disorders : From risk stratification to interventional procedures].

Cardiac magnetic resonance imaging (cMRI) now rates among the established diagnostic procedures for the clarification of cardiac disease patterns. In modern clinical electrophysiology, apart from providing basic cardiac diagnostics of patients prior to interventional procedures, the imaging method enables the three-dimensional reconstruction of cardiac target structures of the planned ablation procedure, which can significantly improve the safety and efficacy of the intervention. Furthermore, cMRI has a high significance with respect to risk stratification during implantable cardioverter defibrillator (ICD) evaluation.

Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation.

Introduction: Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan.

Cardiovascular magnetic resonance-based predictors of complete left ventricular systolic functional recovery after rhythm restoration in patients with atrial tachyarrhythmia.

Aims: To establish a cardiovascular magnetic resonance (CMR)-based prediction model for complete systolic left ventricular ejection fraction (LVEF) recovery for the distinction of 'arrhythmia-induced' from 'arrhythmia-mediated' cardiomyopathy in patients with atrial tachyarrhythmias.

Methods And Results: Two hundred and fifty-three tachyarrhythmia patients referred for catheter ablation were enrolled and underwent CMR baseline imaging; patients with a reduced LVEF <50% at baseline and CMR imaging at 3-month follow-up after successful rhythm restoration constituted the final study population (n = 134). CMR at baseline consisted of standard functional cine imaging, determination of extracellular volume, and late gadolinium enhancement (LGE) imaging; follow-up CMR comprised standard functional cine imaging.

Upstream Statin Therapy and Long-Term Recurrence of Atrial Fibrillation after Cardioversion: A Propensity-Matched Analysis.

The relationship of statin therapy with recurrence of atrial fibrillation (AF) after cardioversion (CV) has been evaluated by several investigations, which provided conflicting results and particularly long-term data is scarce. We sought to examine whether upstream statin therapy is associated with long-term recurrence of AF after CV. This was a single-center registry study including consecutive AF patients ( = 454) undergoing CV.

Evaluation of the right heart using cardiovascular magnetic resonance imaging in patients with cardiac devices.

Background: Patients with cardiac implantable electronic devices (CIED) necessitate comprehensive cardiovascular magnetic resonance (CMR) examinations. The aim of this study was to provide data on CMR image quality and feasibility of functional assessment of the right heart in patients with CIED depending on the device type and imaging sequence used.

Methods: 120 CIED carriers (Insertable cardiac monitoring system, n = 13; implantable loop-recorder, n = 22; pacemaker, n = 30; implantable cardioverter-defibrillator (ICD), n = 43; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12) underwent clinically indicated CMR imaging using a 1.

Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms.

Background: Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms.

Methods: 212 consecutive ICD patients underwent 1.

Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia.

Purpose: Signal-averaged ECG (SAECG) can detect inhomogeneous myocardial conduction in patients presenting with ventricular tachycardia (VT) after myocardial infarction. Radiofrequency ablation (RFCA) aims at elimination of the endocardial late potentials and non-inducibility of VT. Previously, we demonstrated that abnormal SAECG at baseline can return to normal after a successful VT ablation.

Combined single-session cardiovascular magnetic resonance: stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation patients with chest pain syndromes prior to catheter ablation.

Aims: To determine the clinical utility of a combined single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating adenosine stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation (AF) patients referred for pulmonary vein isolation (PVI) and complaining about chest pain syndromes.

Methods And Results: The preprocedural CMR examination (adenosine stress perfusion, late gadolinium enhancement, and three-dimensional pulmonary vein angiography) was performed in 357 consecutive AF patients with chest pain syndromes referred for PVI. Stress perfusion results were used for stratification: ischaemia positive patients underwent invasive coronary angiography, ischaemia negative patients underwent PVI, and follow-up/outcome data were collected (combined primary endpoint of cardiac death/non-fatal myocardial infarction).

Agreement between gadolinium-enhanced cardiac magnetic resonance and electro-anatomical maps in patients with non-ischaemic dilated cardiomyopathy and ventricular arrhythmias.

Aims: We sought to investigate the overlap between late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and electro-anatomical maps (EAM) of patients with non-ischaemic dilated cardiomyopathy (NIDCM) and how it relates with the outcomes after catheter ablation of ventricular arrhythmias (VA).

Methods And Results: We identified 50 patients with NIDCM who received CMR and ablation for VA. Late gadolinium enhancement was detected in 16 (32%) patients, mostly in those presenting with sustained ventricular tachycardia (VT): 15 patients.

[Management of syncope in clinical practice : What has changed according to the new ESC guidelines 2018?].

Syncope is a common problem in clinical practice, which affects approximately 1% of patients admitted to European emergency departments. The clinical practice guidelines for the diagnosis and management of syncope published by the European Society of Cardiology (ESC) are based on the newest scientific data in the field and have provided clinical cardiologists with a structured therapeutic approach for affected patients over many years. The previous ESC guidelines on syncope were published in 2009 and are compared to the most recent edition, which was published in 2018.

Clinical workflow and applicability of electrophysiological cardiovascular magnetic resonance-guided radiofrequency ablation of isthmus-dependent atrial flutter.

Aims: To determine safety and efficacy of electrophysiological cardiovascular magnetic resonance (EP-CMR)-guided radiofrequency (RF) ablation in patients with typical right atrial flutter in a routine clinical setting.

Methods And Results: Thirty patients with typical right atrial flutter underwent clinically indicated EP-CMR-guided cavotricuspid isthmus ablation. EP-CMR protocols included pre- and post-ablation CMR imaging (whole heart, T2-weighted, and early-/late-gadolinium enhancement) together with electroanatomic mapping of the right atrium.

Characteristics of the ablation lesions in cardiac magnetic resonance imaging after radiofrequency ablation of ventricular arrhythmias in relation to the procedural success.

Background: In human patients, studies about the cardiac magnetic resonance (CMR) appearance of the acute radiofrequency (RF) lesions in relation to the procedural outcomes after catheter ablation (CA) of ventricular arrhythmias (VA) are scarce. We aimed to investigate the RF lesions characteristics in relation to the procedural success.

Methods: Patients referred for ablation of VA received CMR (1.

Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT.

Objectives: We aimed to assess the diagnostic performance of a combined protocol with coronary computed tomography angiography (CCTA) and stress CT perfusion imaging (CTP) in heart transplant patients for comprehensive morphological and functional imaging.

Methods: In this prospective study, 13 patients undergoing routine follow-up 8±6 years after heart transplantation underwent CCTA and dynamic adenosine stress CTP using a third-generation dual-source CT scanner, cardiac magnetic resonance (MR) adenosine stress perfusion imaging at 1.5 T, and catheter coronary angiography.

Fusion of CT coronary angiography and whole-heart dynamic 3D cardiac MR perfusion: building a framework for comprehensive cardiac imaging.

The purpose of this work was to develop a framework for 3D fusion of CT coronary angiography (CTCA) and whole-heart dynamic 3D cardiac magnetic resonance perfusion (3D-CMR-Perf) image data-correlating coronary artery stenoses to stress-induced myocardial perfusion deficits for the assessment of coronary artery disease (CAD). Twenty-three patients who underwent CTCA and 3D-CMR-Perf for various indications were included retrospectively. For CTCA, image quality and coronary diameter stenoses > 50% were documented.

Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality.

Aims: To prospectively determine evaluability of routine cardiovascular magnetic resonance (CMR) diagnostic modules in a referral population of implanted rhythm device all-comers, and to establish a device-dependent CMR imaging strategy to achieve optimal image quality.

Methods And Results: One hundred and twenty-eight patients with cardiac implantable electronic devices [insertable cardiac monitoring system, n = 14; implantable loop-recorder, n = 21; pacemaker, n = 31; implantable cardioverter-defibrillator (ICD), n = 50; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12] underwent clinically indicated CMR at 1.5 T.

Multi-centre study of whole-heart dynamic 3D cardiac magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: gender based analysis of diagnostic performance.

Aims: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in women and non-invasive testing for CAD in women can be more challenging than in men. This study compared the diagnostic performance of whole-heart dynamic 3D cardiovascular magnetic resonance (CMR) stress perfusion imaging in female and male patients with quantitative coronary angiography (QCA) and fractional flow reserve (FFR) as reference tests.

Methods And Results: Four hundred sixteen patients with suspected or known CAD were enrolled in five European centres.

3D fusion of coronary CT angiography and CT myocardial perfusion imaging: Intuitive assessment of morphology and function.

Background: The objective of this work was to support three-dimensional fusion of coronary CT angiography (coronary CTA) and CT myocardial perfusion (CT-Perf) data visualizing coronary artery stenoses and corresponding stress-induced myocardial perfusion deficits for diagnostics of coronary artery disease.

Methods: Twelve patients undergoing coronary CTA/CT-Perf after heart transplantation were included (56 ± 12 years, all males). CT image quality was rated.

Subacute and Chronic Left Ventricular Myocardial Scar: Accuracy of Texture Analysis on Nonenhanced Cine MR Images.

Purpose To test whether texture analysis (TA) allows for the diagnosis of subacute and chronic myocardial infarction (MI) on noncontrast material-enhanced cine cardiac magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 120 patients who underwent cardiac MR imaging and showed large transmural (volume of enhancement on late gadolinium enhancement [LGE] images >20%, n = 72) or small (enhanced volume ≤20%, n = 48) subacute or chronic ischemic scars were included. Sixty patients with normal cardiac MR imaging findings served as control subjects.

ECG morphology of premature ventricular contractions predicts the presence of myocardial fibrotic substrate on cardiac magnetic resonance imaging in patients undergoing ablation.

Background: The most likely origin of premature ventricular contractions (PVCs) may be deduced from surface electrocardiogram (ECG) analysis while planning an electrophysiological study (EPS). Apart from purely benign forms of increased ventricular ectopy, myocardial substrate (e.g.

Artefact-free late gadolinium enhancement imaging in patients with implanted cardiac devices using a modified broadband sequence: current strategies and results from a real-world patient cohort.

Aims: Cardiac magnetic resonance (CMR) imaging in patients with implanted cardiac devices is often limited by device-related imaging artefacts. Limitations can potentially be overcome by employing a broadband late gadolinium enhancement (LGE)-CMR imaging technique. The purpose of this study was to investigate the relationship between implanted cardiac devices and the optimal frequency offset on broadband LGE-CMR imaging to increase the artefact-free visibility of myocardial segments.