ArticleEuropean heart journal. Imaging methods and practice2025
Workflow and imaging strategies for real-time MR-guided atrial transseptal puncture.
Article in European heart journal. Imaging methods and practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Interventional MRI-Guided Ablation of Left Ventricular Tachycardia.Circulation · 2026Article
- Evolution of Radiofrequency Transseptal Puncture Devices.Medical devices (Auckland, N.Z.) · 2026Review
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Interventional cardiac magnetic resonance imaging (iCMR) offers distinct advantages for guiding complex cardiac procedures, including 3D visualization, soft tissue characterization, and avoidance of ionizing radiation. Transseptal puncture (TSP), essential for left heart access, poses specific challenges under MR-guidance. The development of MR-compatible TSP sets comprising non-ferromagnetic sheaths, dilators, and needles, represents a major step toward safe execution of TSP in the MRI environment. This report provides practical, step-by-step guidance for MR-guided TSP, focusing on imaging strategies and integration of advanced 2D and 3D navigation tools. Real-time cine imaging in dedicated planes enables precise localization of the fossa ovalis, confirmation of septal tenting, and avoidance of adjacent structures. Complementary use of a vendor-neutral MR-compatible 3D navigation system allows dynamic catheter tracking within a segmented static 3D anatomical shell, enhancing spatial orientation and procedural accuracy. Feasibility was demonstrated in a porcine model, where an MR-compatible sheath and trackable dilator were successfully navigated to the interatrial septum and TSP was achieved, enabling left atrial (LA) access. Subsequent mapping confirmed catheter positioning within the LA. Remaining challenges include limited guidewire visibility, low image temporal resolution compared with fluoroscopy, and the investigational status of current MR-compatible TSP sets. These factors must be addressed before clinical translation. In conclusion, MR-guided TSP using dedicated imaging planes and MR-compatible devices is technically feasible and may facilitate future radiation-free left heart interventions. Continued device refinement, including improved passive instrument visibility and active tracking technologies, faster real-time cine imaging, and regulatory approval are critical for safe and widespread clinical adoption.
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