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Title: Cardiac magnetic resonance in catheter ablation of atrial arrhythmias : characterisation of substrate and guidance of therapy
Author: Harrison, James Lloyd
ISNI:       0000 0004 5357 3785
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2014
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Cardiac magnetic resonance (CMR) imaging has been recently used to provide non-invasive tissue characterisation before and after catheter ablation of atrial arrhythmias and to guide real-time electrophysiology procedures within the CMR environment. This thesis develops and validates new CMR techniques for use at the interface between cardiac imaging and interventional electrophysiology using both pre-clinical animal and clinical human studies. There are three main objectives: 1) Whilst the use of CMR to characterise acute and chronic ventricular myocardial injury only became clinically accepted and in widespread use following comprehensive pathological validation, there has been no fundamental validation work on the CMR assessment of the atrium. This thesis provides the first comprehensive histological validation of CMR and electroanatomical mapping (EAM) of acute and chronic ablation injury in a new animal model of atrial ablation. 2) Previous studies have suggested a qualitative and quantitative relationship between atrial CMR findings and endocardial voltage. However, there is conflicting evidence regarding the reproducibility and diagnostic accuracy of atrial CMR as a surrogate for electrical disease. This thesis compares atrial CMR findings with endocardial voltage mapping in patients undergoing repeat catheter ablation for left atrial (LA) arrhythmias and assesses the ability of atrial CMR to predict gaps in ablation lesions. 3) The final objective of the thesis is to assess the feasibility of a real-time magnetic resonance-guided electrophysiology (MR-EP) system in an animal model of atrial ablation. MR-EP offers several potential advantages over x-ray fluoroscopy and conventional EAM systems. It provides rapid, high resolution, 3D visualisation of the true anatomy and endocardial surface of the cardiac chambers with unrivalled soft tissue contrast, the potential to visualise ablation lesions and acute complications with high spatial resolution, and raises the possibility of eliminating patient and physician exposure to ionising radiation. This thesis demonstrates, for the first time, the feasibility of using an actively-tracked radiofrequency (RF) ablation catheter within a fully MR-compatible EP system as a prelude to a planned human study.
Supervisor: O'Neill, Mark; Razavi, Reza Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available