Intramyocardial Therapy: a Novel Accurate and Fast Method to Target the Infarct Border Zone

Introduction: For the optimal application of cardiac regenerative therapy in ischemic heart disease, targeting of the correct location to perform intramyocardial injections is of the utmost importance. The general consensus is that this treatment is best delivered to the infarct border zone (IBZ). We have developed software that enables the visualization of MRI defined targets on live fluoroscopic images. In this study we have compared the clinical standard for intramyocardial injections, the NOGA system, with CARTBox2. Methods: Ten pigs (60-75kg) were subjected to a 90 minute balloon occlusion of the LAD. Four weeks later, a late gadolinium enhanced (LGE) MRI scan was performed. Subsequently, 10-16 injections were delivered in the IBZ using either the NOGA system or CARTBox2. The primary endpoint was the distance of the injections to the IBZ. Secondary endpoints were total procedure time, fluoroscopy time and dose and number of ventricular arrhythmias. Results: The average distance of the injections to the IBZ was similar for NOGA (-0.7±2.2 mm) and CARTBox2 (0.5±3.2 mm), (p=ns). The procedure time with CARTBox2 (69±12 minutes) was significantly shorter than with NOGA (150±12 minutes) (p<0.001). The fluoroscopy time with NOGA (18.7±11.0 minutes) was significantly lower than with CARTBox2 (43.4±6.5 minutes; p=0.0003). Procedures with CARTBox2 caused less ventricular arrhythmias than NOGA (p=ns). Conclusions: CartBox2 is an accurate and fast vendor independent system to facilitate intramyocardial injections based on gold standard non-invasive LGE-MRI fibrosis imaging.