Pranav Bhagirath

121 Interventional cardiac magnetic resonance imaging in electrophysiology: advances toward clinical translation Tamponade Cardiac tamponade is a potentially life threatening complication associated with ablative therapy. The incidence varies for the different interventions with numbers reported up to 6%. Current guidelines advise immediate echocardiography in case hypotension develops. Confirmation of this diagnosis is followed by pericardiocentesis to drain the excessive fluid from the pericardial space. Due to variations in the anatomy, this sometimes results in a complex procedure. In conventional fluoroscopic rooms, this is best performed using echocardiography. In case of iCMR, there are various sequences that can diagnose and potentially locate the lesion. In addition, a recent animal study demonstrated the feasibility of performing pericardiocentesis inside the scanner room using commercially available needles 39 . In total 12 successful procedures (no complications) were performed using a real-time imaging approach and passive tracking of the needle. This development increases the practicability of complex ablative therapy in the scanner and significantly expands the emergency solving capacity of iCMR. SAR The specific absorption rate (SAR) indicates the amount of radio-frequency energy deposited inthe tissue.Thesafety limit, as indicatedby theFoodandDrugAdministration, for whole body SAR is 4W/Kg/15 minutes exposure and should be monitored during the procedure. In case this limit is exceeded, scanning should be stopped to allow recovery of the tissue. In general, this situation can also be prevented by increasing the repetition time (TR) or reducing the flip angle. Defibrillation Performing EP procedures in an iCMR suite requires a meticulously constructed evacuation plan. This is especially required for patients on respiratory support and with a multitude of monitors attached. A possible solution could be integrating monitoring and ventilation with the scanner table. This would allow emergency cases to be rapidly shifted towards a room where defibrillation and other resuscitative actions can be performed without any restrictions. Electrical mapping of arrhythmias is performed by inducing the tachycardia by means of stimulation protocols. Especially in case of ventricular tachyarrhythmia’s this can cause hemodynamic instability in patients and forces cardioversion to be performed. Currently, there is no solution allowing defibrillation to be performed inside an iCMR suite. In case of diagnostic scans, this has not been a limiting factor, as a patient can be transported out of the magnet within few seconds. This changes when a patient is