Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology

MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.

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Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

Current Cardiology Reports ◽

10.1007/s11886-021-01461-y ◽

2021 ◽

Vol 23 (4) ◽

Author(s):

Christopher S. Purtell ◽

Ryan T. Kipp ◽

Lee L. Eckhardt

Keyword(s):

Cardiac Electrophysiology ◽

Imaging Technique ◽

Early Experience ◽

Intracardiac Echocardiography ◽

Electroanatomic Mapping ◽

Supporting Evidence ◽

Device Implantation ◽

Mri Guidance ◽

Fluoroscopic Imaging ◽

Mapping Systems

Abstract Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.

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Cell-Based Regeneration and Treatment of Liver Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms221910276 ◽

2021 ◽

Vol 22 (19) ◽

pp. 10276

Author(s):

Julia Hofmann ◽

Verena Hackl ◽

Hannah Esser ◽

Andras T. Meszaros ◽

Margot Fodor ◽

...

Keyword(s):

Liver Diseases ◽

Ex Vivo ◽

Organ Shortage ◽

Clinical Implementation ◽

Organ Function ◽

Novel Technologies ◽

Recent Developments ◽

Underlying Mechanisms ◽

The Moment ◽

End Stage

The liver, in combination with a functional biliary system, is responsible for maintaining a great number of vital body functions. However, acute and chronic liver diseases may lead to irreversible liver damage and, ultimately, liver failure. At the moment, the best curative option for patients suffering from end-stage liver disease is liver transplantation. However, the number of donor livers required by far surpasses the supply, leading to a significant organ shortage. Cellular therapies play an increasing role in the restoration of organ function and can be integrated into organ transplantation protocols. Different types and sources of stem cells are considered for this purpose, but highly specific immune cells are also the focus of attention when developing individualized therapies. In-depth knowledge of the underlying mechanisms governing cell differentiation and engraftment is crucial for clinical implementation. Additionally, novel technologies such as ex vivo machine perfusion and recent developments in tissue engineering may hold promising potential for the implementation of cell-based therapies to restore proper organ function.

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Real-time monitoring of cardiac radio-frequency ablation lesion formation using an optical coherence tomography forward-imaging catheter

Journal of Biomedical Optics ◽

10.1117/1.3459134 ◽

2010 ◽

Vol 15 (3) ◽

pp. 030516 ◽

Cited By ~ 32

Author(s):

Christine P. Fleming ◽

Hui Wang ◽

Kara J. Quan ◽

Andrew M. Rollins

Keyword(s):

Optical Coherence Tomography ◽

Radio Frequency ◽

Real Time ◽

Radio Frequency Ablation ◽

Optical Coherence ◽

Ablation Lesion ◽

Real Time Monitoring ◽

Lesion Formation

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Prediction of radiofrequency ablation lesion formation using a novel temperature sensing technology incorporated in a force sensing catheter

Heart Rhythm ◽

10.1016/j.hrthm.2016.11.013 ◽

2017 ◽

Vol 14 (2) ◽

pp. 248-254 ◽

Cited By ~ 16

Author(s):

Guy Rozen ◽

Leon Ptaszek ◽

Israel Zilberman ◽

Kevin Cordaro ◽

E. Kevin Heist ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Temperature Sensing ◽

Force Sensing ◽

Ablation Lesion ◽

Lesion Formation ◽

Sensing Technology

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Pharmacogenetics of antipsychotic therapy: pivotal research issues and the prospects for clinical implementation

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2006.8.1/blerer ◽

2006 ◽

Vol 8 (1) ◽

pp. 85-94 ◽

Cited By ~ 1

Keyword(s):

Adverse Effects ◽

Genetic Factors ◽

Association Studies ◽

Environment Interaction ◽

Clinical Implementation ◽

Antipsychotic Therapy ◽

Research Issues ◽

Recent Developments ◽

And Gender ◽

The Individual

The core hypothesis underlying pharmacogenetics is that genetic factors play a significant role in the well-recognized differences between individuals in response to medication and susceptibility to adverse effects. If these genetic factors can be identified and understood, they may serve as predictors to guide clinicians in tailoring medication to the individual patient. Recent developments in the field of antipsychotic drug treatment suggest that pharmacogenetics could play an important role, permitting the use of first-generation antipsychotics (FGAs) for patients in whom the use of second-generation antipsychotics (SGAs) is limited by efficacy considerations or adverse effects. In this paper, key issues that need to be taken into consideration in designing and interpreting pharmacogenetic studies of antipsychotic drugs are discussed against the background of data emanating from studies on the genetics of tardive dyskinesia (TD), an important adverse effect of FGAs. The issues considered include the advantages and potential pitfalls of case-control association studies of pharmacogenetic traits, the role of demographic factors such as age and gender, additive effects of genes, and gene-gene and gene-environment interaction. The prospects for implementation of pharmacogenetic testing in the clinic are considered in the context of a preliminary model that has been tested for prediction of susceptibility to TD.

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Oesophageal thermal protection during AF ablation: effect on left atrial myocardial ablation lesion formation and patient outcomes

EP Europace ◽

10.1093/europace/euab116.253 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

L Leung ◽

A El Batran ◽

G Dhillon ◽

A Bajpai ◽

Z Zuberi ◽

...

Keyword(s):

Patient Outcomes ◽

Left Atrial ◽

Standard Care ◽

Thermal Injury ◽

Ablation Lesion ◽

Rf Ablation ◽

Lesion Formation ◽

Private Company ◽

Oesophageal Temperature ◽

Af Ablation

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dr Leung has received research support from Attune Medical (Chicago, IL). Dr Gallagher has received research funding from Attune Medical (Chicago, IL). Background Randomized evidence has shown that controlled oesophageal cooling is effective at reducing oesophageal thermal injury during radiofrequency (RF) ablation for atrial fibrillation (AF) compared to standard care. The effect of oesophageal cooling on ablation lesion formation in left atrial myocardium and patient outcomes at 12-months had not been previously studied. Purpose To determine the effect of oesophageal cooling on the formation of RF lesions, the ability to achieve procedural endpoints and long-term patient outcomes compared to standard care ablations. Methods Ablation results and patient outcomes from a double-blind randomized controlled trial were analysed (IMPACT trial NCT03819946). AF ablation was guided by Ablation Index technology (30W at 350-400 AI posteriorly, 40W at 450 AI anteriorly). A blinded 1:1 randomization assigned patients to the use of an oesophageal temperature control device to keep oesophageal temperature at 4 degrees during ablation or standard practice using a single-sensor temperature probe. Ablation parameters and 12-month outcomes were analysed. Results We recruited 188 patients. Procedure and fluoroscopy times were similar. First pass pulmonary vein isolation and reconnection at the end of the waiting period were similar in both randomized groups (51/64 vs 51/68; p = 0.54 and 5/64 vs 7/68; p = 0.76, respectively). Posterior wall isolation was also similar: 24/33 vs 27/38; p = 0.88. Ablation effect on myocardial tissue, measured in impedance drop, was also similar: 8.6Ω (IQR: 6-11.8) vs 8.76Ω (IQR: 6-12.2; p = 0.25) and median catheter tip temperature was the same at 25.5 degrees. Arrhythmia recurrence was similar at 12 months (20.3% vs 26.8%, from 142 completed assessments; p = 0.66). Conclusions Oesophageal cooling has been shown to be effective in reducing ablation-related oesophageal thermal injury during RF ablation. Ablation data show that this protection does not make it any more difficult to achieve standard procedural endpoints or clinical success at 12-months. Abstract Figure. Pyramid frequency plots of AI values

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High-power, Short-duration Radiofrequency Ablation for the Treatment of AF

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2019.09 ◽

2020 ◽

Vol 8 (4) ◽

pp. 265-272 ◽

Cited By ~ 1

Author(s):

Irum D Kotadia ◽

Steven E Williams ◽

Mark O’Neill

Keyword(s):

Radiofrequency Ablation ◽

Short Duration ◽

High Power ◽

Clinical Studies ◽

Ablation Lesion ◽

Lesion Formation ◽

Clinical Value ◽

Temperature Recording ◽

Procedural Time ◽

Tissue Oedema

High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges for HPSD ablation has been the inability to adequately assess temperature and lesion formation in real time. Novel catheter designs may improve the accuracy of intra-ablation temperature recording and correspondingly may improve the safety profile of HPSD ablation. Clinical studies of HPSD ablation are on-going and interpretation of the data from these and other studies will be required to ascertain the clinical value of HPSD ablation.

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