Advances in MRI Technology and Techniques: An Interview with Eugene Kholmovski, PhD

Understanding how we can apply technology to improve clinical practices is the wellspring for innovation. As scientists from a wide range of disciplines are continually pushing the limits of what’s possible, researchers and clinicians must work with them to develop new techniques to take advantage of these capabilities. This kind of interdisciplinary collaboration is a cornerstone of the University of Utah’s Comprehensive Arrhythmia Research & Management Center (CARMA), whose mission is to provide worldwide pioneering leadership in advancing clinical treatments and research for cardiac arrhythmias, especially atrial fibrillation (AF). To gain insights into how technology, specifically the use of advanced MRI, is changing clinical treatment of AF, we spoke to Eugene Kholmovski, PhD, an Assistant Professor at the Utah Center for Advanced Imaging Research. How long have you been working with CARMA and what is your primary role? Dr. Kholmovski: I started four years ago before CARMA even had a name, and the main focus of my research was developing and optimizing an MRI technique for clinical use in the treatment of atrial fibrillation. When I began, the main application of MRI for AF was angiography of the left atrium and pulmonary veins, which were used to study the anatomy of the LA and PVs as a guide for ablation treatment. What are some of the novel techniques of MRI that have resulted from your research? Dr. Kholmovski:The late gadolinium enhancement (LGE) sequence that I developed has been the critical component of the Utah Classification System (UCS), a disease progression model that is beneficial in planning corresponding ablation strategies and anticoagulation management. Currently, novel MRI techniques can be used to study remodeling of the atrial wall caused by AF, detect post-AF ablation scar, rule out complications and predict the outcomes of ablation procedures. How have the speed and quality of the images improved? Dr. Kholmovski: Over the last four years, we have optimized the LGE sequence to make it less dependent on patient heart rates or respiration patterns. The scan times have been reduced at least by a factor of 2, and the image quality has improved by leaps and bounds. When we started, the clinically acceptable image quality was about 50% of scans, and now it’s more than 90%. We have separate protocols for awake and sedated patients to ensure their comfort and good image quality during acquisition. What have you done to help other medical centers adopt the UCS and novel MRI techniques? Dr. Kholmovski: I have personally visited 10 of the centers participating in the University of Utah’s DE-MRI Determinant of Successful Radiofrequency Catheter Ablation of Atrial Fibrillation (DECAAF) study (June blog), which began in 2010. I have installed the DECAAF pulse sequences, trained the centers’ personnel and am regularly following up with them with feedback and ideas for improving their image quality. How will MRI for AF treatment change in the next few years? Dr. Kholmovski: There is a lot of exciting research being done — in both hardware and software — that will enable ablation procedures in the MRI suite. Two years ago, CARMA opened the first integrated EP-MRI clinical and research lab in North America with Siemens’ 9-ton MAGNETOM Verio 3T. This kind of integration is where the future of MRI for AF is heading. If you have any questions about MRI and AF, or would like to discuss this with Dr. Kholmovski, you can contact him at ekhoumov@ucair.med.utah.edu. Nassir F. Marrouche, MD is the Executive Director of the Comprehensive Arrhythmia Research & Management Center, Director of Electrophysiology Laboratories, and Director of the Atrial Fibrillation Program at the University of Utah School of Medicine, Division of Cardiology.