Pranav Bhagirath

113 Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation going adjustments to the imaging plane by the operator. This is a difficult and time consuming task that requires skilled operators. Furthermore, incorrect imaging plane selection during in-plane manipulation can result in loss of device visualization andmay increase procedural duration. In addition, loss of anatomical information might occur in the area surrounding the artifact, reducing differentiation between various tissues and may hamper precise navigation. Despite these disadvantages, both diagnostic EP procedures and ablations have been successfully performed in patients using passive tracking ( figure 2a ) 27, 31 . Active Active tracking is performed using small radio-frequency receiver coils built into the device. Imaging sequences can interrogate the location of these coils and allow for real-time, device only navigation 33 . The current EP procedures often require multiple different (multi-electrode) catheters. To get accurate orientation of a catheter and be able to use pre-determined models of the shape of the distal end of the catheter where the electrodes are placed, at least 2 active coils are needed. These coils have a hypothetical danger of heating due to RF coupling 34 . There have however been a number of strategies developed to address this 35 . However, due to this safety concern, active tracking has so far only been studied in animal models ( figure 2b ) 11, 23, 24, 29 . Initial reports did not encounter any adverse events. Differences between device tracking a. Passive tracking b. Active tracking Figure 2. Different device tracking strategies. Left panel depicts passive tracking, an approach utilizing the susceptibility artifact (white arrows) for device visualization. Right panel depicts the active tracking approach using micro- coils on the device resulting in multiple benefits including improved visualization update (achievable within a few milliseconds) and device guided navigation.