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Background Efforts are underway to perform MRI-guided cardiac ablations in the magnet. The chief motivations are: 1) the ability to see the effects of treatment, 2) improved catheter positioning during mapping and therapy, and 3) avoiding ionizing radiation and iodinated contrast agent from x-ray. However, current efforts use gadolinium-based contrast agents (GBCAs) to obtain MR Angiogram (MRA) for anatomical context and late gadolinium enhancement (LGE) for enhancement of ablation lesions. There may be motivations to limit use of GBCAs, both in the specific context of an ablation procedure and in general use. The general use motivation is health-based, as the FDA is investigating the risk of gadolinium deposits in the brain after repeated use of GBCAs. Another motivation is for accuracy in assessment of acute lesions, since wash-in/out kinetics make it difficult to infer lesion size from enhancement regions in LGE images, even with carefully chosen timing and imaging parameters. The typical LGE protocol requires waiting 10-15 minutes after contrast agent injection before T1w imaging. This protocol is both unpractical to run repeatedly and limited by contrast-agent dose. It may be possible to perform this procedure without GBCAs. We focus on the acquisition of images for MRA, real-time navigation and lesion assessment. We present proof-of-concept data in swine left ventricle (LV).

Towards MRI-guided cardiac ablation procedures with no contrast agent: safety and efficacy considerations