Over the past decade, the most notable change in everyday practice in the management of atrial fibrillation (AF) has been the use of 3D imaging and energy sources to facilitate catheter ablations. Yet despite considerable scientific and economic investments, outcomes for AF ablation procedures have not markedly improved. This can be attributed to two factors: 1) the lack of a standard protocol for selecting an appropriate ablation candidate, and 2) the inability to monitor lesion formation in real time to ensure that appropriate ablation therapy was delivered during the procedure.

These issues are now being addressed through the integration of tissue structural visualization and treatment into the EP lab. As reported at this year’s European Society of Cardiology (ESC) annual meeting in Paris, interventional MR and interventional MRI EP lab suites are becoming more commonplace. Various groups from Europe and the US are reporting feasibility and safety data that apply the real-time MRI concept for delivering atrial and ventricular lesions.

For the first time at ESC, an entire session was dedicated to arrhythmia and MRI, for which I privileged to serve as its moderator and chairperson. Dr. Timm Dickfeld presented an elegant review of the progress and challenges in integrating the EP lab into our daily life (slides), including the latest advances from the University of Utah regarding real-time visualization of catheter and lesion formation during AF. Dr. Anil-Martin Sinha covered new strategies for patient selection (slides), while Drs. J. Schwitter (slides) and John Gorcsan (slides) discussed image integration, follow-up and procedural outcome prediction.

Interventional MRI enables physicians to identify atrial tissue fibrotic changes, which define disease progression, to visualize in real time lesion formation in the EP lab. The presentations at ESC provide the most compelling evidence to date that MRI is becoming an essential part of the life of every physician treating AF.

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.