With the advent of the Stereotaxis remote catheter navigation technology (Stereotaxis, Inc., St. Louis, Missouri), we saw an opportunity to improve our ability to perform complex ablation procedures while maximizing the capabilities of an advanced 3-D mapping system. By reducing the risk of catheter perforation, limiting fluoro exposure and improving accuracy, these two systems provide a unique marriage of capabilities for our EP lab.

A Simple, Straightforward Combination

Over the past decade, there has been a concerted effort by health professionals, industry, and the government to reduce sudden cardiac death (SCD) caused by ventricular arrhythmias. One of the major milestones in cardiovascular disease has been the realization that an implantable cardioverter defibrillator (ICD) can significantly reduce mortality in a select group of patients.^4,11 We now know from multiple randomized controlled trials that patients with a reduced ejection fraction (EF), prior history of cardiac arrest, and heart failure symptoms are at highest risk from a fatal ventricular arrhythmia.^5,6,12 Furthermore, the duration of disease increases the risk of sudden cardiac death.^12,13 Unfortunately, the method of risk stratifying patients for ICDs is neither 100% sensitive nor specific. As a result, some patients may have ICD implantation without any subsequent life-threatening arrhythmias.

The official advice has always been, no MRI if your patient has an implantable pacemaker or defibrillator. Although it is still recommended that such patients not undergo MRI, two recent studies have suggested that MRI could be possible, if the scan is absolutely necessary. Nazarian et al looked at 68 MRI studies in 55 patients with a device.¹ They excluded patients with older devices that might be more prone to failure with an MRI. The authors found no significant changes in the device with the MRI (including 29 thoracic MRI studies right over the device). Sommer et al looked at 82 patients with fairly new Medtronic pacemakers who underwent MRI scans (most were brain MRIs), and none had long-term damage to the pacemaker.²