First-in-Human Real-Time MR-Guided Ventricular Ablation for Idiopathic Outflow Tract Premature Ventricular Complexes

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Interventional Cardiology

Background:

• Current catheter ablation for ventricular arrhythmias uses fluoroscopy and electroanatomic mapping, lacking soft-tissue detail and involving ionizing radiation.
• Real-time magnetic resonance (MR)-guided ablation offers potential advantages by providing direct visualization of cardiac anatomy and lesion formation in a radiation-free environment.

Purpose of the Study:

• To demonstrate the technical feasibility and safety of the first-in-human real-time MR-guided radiofrequency ventricular ablation.
• To assess the efficacy of MR-guided ablation in treating symptomatic ventricular arrhythmias.

Main Methods:

• A prospective, first-in-human roll-in case from the VISABL-VT trial.
• Procedure performed in an MR imaging (MRI) suite with a dedicated MR-compatible electrophysiology platform and real-time catheter tracking.
• Radiofrequency ablation guided by real-time MRI, including MR angiography for roadmap and actively tracked catheters for mapping and ablation.

Main Results:

• The procedure was performed successfully under real-time MRI guidance without complications.
• Premature ventricular complexes (PVCs) were completely suppressed, with no recurrence at 30-minute observation or 2-month follow-up.
• Lesion formation was confirmed via postprocedural MRI.

Conclusions:

• This first-in-human case establishes the safety and effectiveness of performing ventricular ablation entirely under real-time MR guidance.
• Further results from the VISABL-VT trial are needed to confirm clinical utility and long-term outcomes.