Ventricular tachyarrhythmias and atrial fibrillation are the most important arrhythmias affecting patients. They are the most frequently encountered tachycardias, account for the most morbidity and mortality, and despite much progress, remain therapeutic challenges. Invasive electrical studies of the heart (electrophysiologic studies) are often used in the diagnosis and therapy of arrhythmias, and may arrhythmias can be cured by selective destruction of critical electrical pathways with radiofrequency (RF) catheter ablation. A major limitation in studying arrhythmias in patients, however, is the lack of ability to accurately correlate anatomical and electrical information. Anatomy is derived from x-ray images, which are two-dimensional and have substantial anatomic ambiguity. Another major limitation is the lack of ability to visualize ablated areas of myocardium during catheter ablation procedures, making it difficult to confirm the presence of ablated lesions in the desired locations. We have developed ways of combining the anatomic information from magnetic resonance imaging (MRI), with electrophysiologic testing and catheter ablation. We hypothesize that magnetic resonance imaging, with transesophageal receivers, intracardiac receivers and MRI- compatible (non-magnetic) electrode catheters, can (1) provide accurate navigation of catheters without radiation, (2) provide the ability to visualize ablated lesions, and (3) aid in producing more accurate electrical maps. As a prototype for the development of new approaches to electrophysiologic testing and catheter ablation, this proposal addresses atrial fibrillation primarily. The imaging technologies developed in this project, should however, be broadly applicable to using MRI to guide interventional procedures in the heart in general, as well as in other organ systems. This project is an ongoing partnership between the Johns Hopkins University School of Medicine, the Johns Hopkins University Applied Physics Laboratory, Surgivision Inc., Robin Medical Inc., and Bard Electrophysiology, Inc., all of which have supplied resources to the project, and will continue to cost share. The School of Medicine is the lead institution and will be (1) developing specifications for advanced imaging and ablation catheter systems, (2) testing new technology as developed, and (3) performing interventional studies. The Applied Physics Laboratory is developing the technology for advanced intracardiac and transesophageal MRI receivers, and is developing software for 3-dimensional reconstruction of MR imaging. Surgivision is developing clinical-grade versions of the MR receivers. Robin Medical is developing technologies for precisely localizing the tip of a catheter inside an MRI scanner. Bard Electrophysiology is supplying non-magnetic electrode catheters for use in the MRI scanner.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL064795-03
Application #
6390713
Study Section
Special Emphasis Panel (ZRG1-SRB (02))
Program Officer
Pearson, Gail D
Project Start
1999-09-30
Project End
2004-08-31
Budget Start
2001-09-01
Budget End
2002-08-31
Support Year
3
Fiscal Year
2001
Total Cost
$689,211
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Pourmorteza, Amir; Keller, Noemie; Chen, Richard et al. (2018) Precision of regional wall motion estimates from ultra-low-dose cardiac CT using SQUEEZ. Int J Cardiovasc Imaging 34:1277-1286
Nazarian, Saman; Hansford, Rozann; Rahsepar, Amir A et al. (2017) Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. N Engl J Med 377:2555-2564
Ngo, Tri M; Fung, George S K; Han, Shuo et al. (2016) Realistic analytical polyhedral MRI phantoms. Magn Reson Med 76:663-78
Ashikaga, Hiroshi; Estner, Heidi L; Herzka, Daniel A et al. (2014) Quantitative Assessment of Single-Image Super-Resolution in Myocardial Scar Imaging. IEEE J Transl Eng Health Med 2:
Pourmorteza, Amir; Schuleri, Karl H; Herzka, Daniel A et al. (2012) A new method for cardiac computed tomography regional function assessment: stretch quantifier for endocardial engraved zones (SQUEEZ). Circ Cardiovasc Imaging 5:243-50
Halperin, Henry R; Nazarian, Saman (2011) Magnetic resonance identification of the ventricular tachycardia critical isthmus: finding the needle in the haystack. J Am Coll Cardiol 57:195-7
Estner, Heidi L; Zviman, M Muz; Herzka, Dan et al. (2011) The critical isthmus sites of ischemic ventricular tachycardia are in zones of tissue heterogeneity, visualized by magnetic resonance imaging. Heart Rhythm 8:1942-9
Nazarian, Saman; Hansford, Rozann; Roguin, Ariel et al. (2011) A prospective evaluation of a protocol for magnetic resonance imaging of patients with implanted cardiac devices. Ann Intern Med 155:415-24
Ranjan, Ravi; Kato, Ritsushi; Zviman, Menekhem M et al. (2011) Gaps in the ablation line as a potential cause of recovery from electrical isolation and their visualization using MRI. Circ Arrhythm Electrophysiol 4:279-86
Kolandaivelu, Aravindan; Zviman, Menekhem M; Castro, Valeria et al. (2010) Noninvasive assessment of tissue heating during cardiac radiofrequency ablation using MRI thermography. Circ Arrhythm Electrophysiol 3:521-9

Showing the most recent 10 out of 22 publications