Magnetic resonance imaging–guided conventional catheter ablation of isthmus-dependent atrial flutter using active catheter imaging

BACKGROUND: Interventional cardiac magnetic resonance (iCMR) has been established as a radiation-free alternative compared to standard fluoroscopy-guided catheter ablation for cavotricuspid isthmus (CTI)-dependent atrial flutter to image anatomy, structural alterations, and further catheter guidance. OBJECTIVE: The purpose of this study was to explore the safety, feasibility, and efficacy of CTI ablations performed completely in the iCMR suite using active catheter imaging. METHODS: Consecutive patients underwent iCMR-guided catheter ablation for CTI-dependent atrial flutter. Procedures were performed in a 1.5-T magnetic resonance (MR) imaging unit with MR-conditional ablation catheters. Catheter guidance was achieved using active catheter imaging via integrated MR receive tip coils. Acute success, periprocedural complications, and short-term follow-up were collected for further analysis. RESULTS: All patients (N = 15; 73% male; median age 70 years; interquartile range [67–82]) achieved acute procedural success without any complication. Median procedural time was 43 minutes [33–58] with median radiofrequency delivery time of 18 minutes [12–26]. Postprocedural lesion visualization scanning was completed in a median of 32 minutes [10–42]. None of the patients with 6-month follow-up had atrial flutter recurrence. CONCLUSION: In the iCMR suite, CTI-dependent atrial flutter ablation could be achieved safely using active catheter imaging without any complication. It further allows detailed anatomic visualization of the CTI, intraprocedural lesion visualization, and exclusion of pericardial effusion.