Cardiac CT/MRI Imaging for Electrophysiology

Abstract

Emergence of new management strategies in cardiac electrophysiology, including catheter ablation and device implantation, has lead to the development of better imaging modalities that provide accurate anatomic characterization Standard fluoroscopy still remains the standard imaging modality during catheter ablation procedures and device implantation However, fluoroscopy is insufficient for detailed imaging of important anatomical structures, and its desirability is also limited by the inherent patient and staff radiation exposure Intracardiac echocardiography (ICE), computed tomography (CT), and magnetic resonance imaging (MRI) provide more detailed anatomic visualization Currently, image integration with either CT or MRI is being used to enhance the acquisition of 3D electroanatomic mapping and to guide radiofrequency ablation This involves imaging of the patient before the procedure and registration of the anatomy at the time of the procedure In the future, real-time MRI would allow true real-time 3D imaging, displaying the exact catheter position in regard to the accurate cardiac anatomy without any ionizing radiation Real-time MRI would allow direct monitoring of surrounding structures such as the esophagus and pericardial space, thus providing real-time feedback to reduce the chance of complications Finally, fusion imaging with two different imaging modalities such as MRI and positron emission tomography (PET) may allow anatomic and metabolic characterization of a left ventricular scar that may provide improved guidance for ventricular tachycardia ablations This chapter provides an overview of different imaging modalities in cardiac electrophysiology with an emphasis on CT and MRI