Figure 1

Workflow of fully CMR-guided cavo-tricuspid isthmus ablation. Pre-intervention CMR imaging included T2-weighted imaging of the cavo-tricuspid isthmus followed by a high-resolution 3D whole-heart scan (nsWHcs); while standard cardiac cine image acquisition proceeded, low latency 3D image segmentation was carried out on a networked external workstation by an automated algorithm with the option to apply extended manual segmentation if needed. EP-CMR intervention (i.e. catheter navigation, radiofrequency ablation, activation mapping) relied on real-time active catheter tracking and was based on 3D endoluminal mesh models together with multiplanar reformatted geometries of the coronary sinus or the cavo-tricuspid isthmus, respectively. Post-intervention CMR imaging consisted of repeat T2-weighted imaging in order to confirm RF-induced myocardial edema of the targeted cavo-tricuspid isthmus line.