The compatibility of MRI with implanted devices such as pace-makers and implantable cardiac defibrillators (ICDs) is also an important consideration in performing interventional MRI studies in the electrophysiology patient population. Particular buy INCB018424 concerns include static magnetic field-induced movement of the device and scanning-induced programming changes, device inhibition, activation of tachyarrhythmia therapies, Inhibitors,research,lifescience,medical and lead currents leading to heating or cardiac stimulation.103–106 Modern devices address some of these concerns with the use of less ferromagnetic material and improved resistance to electromagnetic interference.107 A number of devices have been carefully studied during in-vitro and

animal MR imaging, and experience is growing for safe cardiac MRI scanning in patients Inhibitors,research,lifescience,medical with selected devices under controlled scanning conditions.25,107,108 This experience includes use of sequences relevant to modern CMR with SAR characteristics similar to those used for real-time MRI.25 Still, the number of patients

and devices studied thus far is limited, and further work is needed to develop manufacturer protocols for establishing conditional MRI safety of pace-makers and ICDs. Carefully designed protocols for patient selection, Inhibitors,research,lifescience,medical monitoring, and scanning also need to be developed before imaging of patients with devices can be more routinely performed. The impact of device-related artifacts on cardiac image interpretation also needs to be more carefully studied. CONCLUSION Increasing knowledge of the anatomic basis for cardiac arrhythmias has extended the role of catheter ablation to curing even complex Inhibitors,research,lifescience,medical rhythms such as atrial fibrillation and scar-based ventricular tachycardia. CMR has demonstrated a number of uses for procedural planning, particularly Inhibitors,research,lifescience,medical for treatment of atrial fibrillation. The use of DEMRI for planning VT ablation procedures also shows promise. Real-time CMR combined with intra-procedural lesion imaging

could allow physicians to accurately guide devices and establish completeness of ablation lines without concern for radiation exposure. This could significantly improve the way current ablation procedures are performed and open the way to ablative cure of arrhythmias such as permanent atrial fibrillation that nearly currently respond poorly to minimally invasive approaches.7 Abbreviations: AF atrial fibrillation; CMR cardiac magnetic resonance imaging; CT computed tomography; DEMRI delayed enhancement MRI; DECMR delayed enhancement CMR; EP electrophysiology; fps frames per second; ICE Intracardiac echocardiography; MRA MRI angiography; MRI magnetic resonance imaging; MVT monomorphic ventricular tachycardia; PV pulmonary vein; RF radiofrequency; SR specific absorption rate; true-FISP true fast imaging with steady-state precession; VT ventricular tachycardia. Footnotes Conflict of interest: No potential conflict of interest relevant to this article was reported.