Pranav Bhagirath

115 Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation active guidewire with embedded fiberoptic temperature probe 38 . Although this new feature does not eliminate the risk of heating, the temperature probe allows accurate monitoring of device heating and contributes towards safer usage of guidewires. Pericardial needles Both passive and active needles have been studied in animals 39, 40 . A comparison between these needles demonstrates favorable results for active tracking. Active needles needed shorter access time (88 vs. 244 sec, P = 0.022), and required significantly fewer needle passes (4.5 vs. 9.1, P = 0.028) 40 . To summarize, recent technical improvements have resulted in the advent of MRI conditional (active trackable) EP tools, including needles, guidewires and (multi- electrode) catheters. IMAGE ACQUISITION Image acquisition for procedural guidance can be divided in three stages; 1) catheter navigation, 2) catheter tip localization prior to ablation, and 3) visualization and evaluation of lesions immediately after ablation. Mandatory sequences for this workflow (e.g. Steady State Free Precession (SSFP), T2 and LGE) are available for both 1.5 T and 3T scanners. Although the various stages require different strategies (e.g. high-quality low temporal resolution procedural roadmap versus high temporal (low-quality) resolution catheter navigation), a standardization of applied sequences and scanning approach is still lacking ( table 2 ). Procedural roadmap The majority of studies conducted so far, do not implement pre-procedurally acquired roadmaps for EP and ablation procedures. This might be due to the limited number of studies investigating redo procedures or evaluating the substrate-based ablation of arrhythmias. A study in a porcine myocardial infarction model reported a good correlation of infarct location on LGE images compared to a MRI-compatible EAM system-based voltagemap 17 . Pre-procedural planning (anatomy and substrate imaging) is essential for complex arrhythmias and integration of this data in iCMR suites should be further investigated.