Key result
iCMR-guided CTI ablation achieves ~91% acute block with no difference between active imaging and tracking.
Why the study?
Interventional cardiac magnetic resonance imaging enables radiation-free ablation and real-time soft-tissue visualization, but its procedural feasibility, efficiency, and clinical outcomes during early clinical use required evaluation using typical atrial flutter ablation as a benchmark.
Is iCMR-guided CTI ablation feasible, efficient, and safe in patients with typical atrial flutter?
Cohort (n=35)
No
Is iCMR-guided CTI ablation feasible, efficient, and safe in patients with typical atrial flutter?
Absolute Event Rate: 26.7% vs 11.8%
p-value: p=0.29
iCMR-guided CTI ablation is feasible and safe for typical atrial flutter, but current first-generation platforms are associated with procedural complexity and a 19% one-year recurrence rate.
May support radiation-free CTI ablation at specialized centers; leaves open need for prospective validation before wider use.
BACKGROUND: Interventional cardiac magnetic resonance imaging (iCMR) enables catheter ablation without ionizing radiation and provides real-time soft-tissue visualization. Recent developments have enabled initial clinical applications, with typical atrial flutter ablation serving as a benchmark to evaluate feasibility. OBJECTIVE: Describe procedural feasibility, efficiency, and clinical outcomes of iCMR-guided cavotricuspid isthmus (CTI) ablation in a single-center cohort. METHODS: We retrospectively analyzed 35 consecutive patients who underwent real-time iCMR-guided CTI ablation between September 2022 and February 2025. Procedures were performed on a 1.5T-MRI scanner using active catheter imaging (ACI,n=15) or active catheter tracking (ACT,n=20). Procedural characteristics, technical performance, acute success, complications, and one-year arrhythmia recurrence were evaluated. RESULTS: Mean age was 66±7 years and 9% were women. Acute bidirectional CTI block could be confirmed in 32/35 patients (91%). Median [IQR] procedure duration was 106[70-128] minutes with ACI and 133[94-161] minutes with ACT (p=0.07). Procedural or technical challenges occurred in 19 patients (54%), most commonly related to coronary sinus catheter positioning and workflow or system-integration issues. No major complications occurred. During one-year follow-up, typical atrial flutter recurred in 6/32 patients (19%) with confirmed CTI block, with no difference between ACI (4/15) and ACT (2/17) (log-rank p=0.29). CONCLUSION: iCMR-guided CTI ablation was feasible and could be performed safely using both ACI and ACT. However, procedural complexity, prolonged procedure times, and recurrence rates reflect the early implementation phase of this first-generation iCMR platform. Ongoing advances in catheter technology, system integration, and workflow optimization are expected to further improve procedural performance and support broader clinical adoption.
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Hopman et al. (2026) conducted a cohort in Typical atrial flutter (n=35). Active catheter imaging (ACI) vs. Active catheter tracking (ACT) was evaluated on Typical atrial flutter recurrence at 1 year among patients with confirmed CTI block (p=0.29). iCMR-guided CTI ablation achieved acute block in 91% of patients, with a 1-year recurrence rate of 19% and no significant difference between active catheter imaging and tracking (P=0.29).
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