75. Role of Magnetic Resonance Imaging in Electrophysiology

  1. Mohammad Shenasa MD3,
  2. Gerhard Hindricks MD4,
  3. Martin Borggrefe MD5,
  4. Günter Breithardt MD6 and
  5. Mark E. Josephson MD7
  1. Anita Wokhlu1 and
  2. Douglas L. Packer2

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch75

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Wokhlu, A. and Packer, D. L. (2013) Role of Magnetic Resonance Imaging in Electrophysiology, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch75

Editor Information

  1. 3

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 4

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 5

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 6

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 7

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    HealthEast HeartCare, St. Joseph's Hospital, St. Paul, MN, USA

  2. 2

    Mayo Clinic, Rochester, MN, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • cardiac magnetic resonance imaging;
  • ventricular tachycardias;
  • electroanatomical mapping systems;
  • atrial fibrillation;
  • delayed gadolinium enhancement;
  • systemic sclerosis;
  • premature ventricular contractions;
  • non-ischemic cardiomyopathies

Summary

Cardiac magnetic resonance imaging (MRI) is a highly accurate non-invasive method for assessing myocardial scar by delayed enhancement imaging. Attempts to correlate electrogram voltage characteristics obtained by catheter-based point mapping to scar detected by MRI suggest that conventional substrate mapping techniques have limitations that could hinder ablative efficacy. This chapter discusses the role of cardiac MRI in the substrate-based ablation of unstable, reentrant ventricular tachycardias prior to ablation, during ablation and after ablation. Prior to ablation, the presence of delayed enhancement and its patterns can provide clues about the potential for reentrant circuits and regions where substrate may be present. During ablation, the integration of MRI-based scar maps with voltage-based scar maps within electroanatomical mapping systems has an emerging role, and may help identify residual channels of conduction embedded within regions of heterogeneous scar. After ablation, particularly in the case of failed ablations, MRI can be used to detect the size and location of previous ablation lesions. While much of this chapter focuses on ventricular substrate detection, the emerging role of MRI for the detection of fibrosis and lesion formation in the thin-walled atria is addressed in the context of atrial fibrillation ablation as well.