Validation of a novel stand-alone software tool for image guided cardiac catheter therapy

René van Es, Hans T van den Broek, Mira van der Naald, Leon de Jong, Eliane R Nieuwenhuis, Adriaan O Kraaijeveld, Pieter A Doevendans, Steven A J Chamuleau, Frebus J van Slochteren

Research output: Contribution to journalArticleAcademicpeer-review


Comparison of the targeting accuracy of a new software method for MRI-fluoroscopy guided endomyocardial interventions with a clinically available 3D endocardial electromechanical mapping system. The new CARTBox2 software enables therapy target selection based on infarction transmurality and local myocardial wall thickness deduced from preoperative MRI scans. The selected targets are stored in standard DICOM datasets. Fusion of these datasets with live fluoroscopy enables real-time visualization of MRI defined targets during fluoroscopy guided interventions without the need for external hardware. In ten pigs (60-75 kg), late gadolinium enhanced (LGE) MRI scans were performed 4 weeks after a 90-min LAD occlusion. Subsequently, 10-16 targeted fluorescent biomaterial injections were delivered in the infarct border zone (IBZ) using either the NOGA 3D-mapping system or CARTBox2. The primary endpoint was the distance of the injections to the IBZ on histology. Secondary endpoints were total procedure time, fluoroscopy time and dose, and the number of ventricular arrhythmias. The average distance of the injections to the IBZ was similar for CARTBox2 (0.5 ± 3.2 mm) and NOGA (- 0.7 ± 2.2 mm; p = 0.52). Injection procedures with CARTBox2 and NOGA required 69 ± 12 and 60 ± 17 min, respectively (p = 0.36). The required endocardial mapping procedure with NOGA prior to injections, leads to a significantly longer total procedure time (p < 0.001) with NOGA. Fluoroscopy time with NOGA (18.7 ± 11.0 min) was significantly lower than with CARTBox2 (43.4 ± 6.5 min; p = 0.0003). Procedures with CARTBox2 show a trend towards less ventricular arrhythmias compared to NOGA. CARTBox2 is an accurate and fast software-only system to facilitate cardiac catheter therapy based on gold standard MRI imaging and live fluoroscopy.

Original languageEnglish
Pages (from-to)225-235
Number of pages11
JournalThe International Journal of Cardiovascular Imaging
Issue number2
Early online date28 Jan 2019
Publication statusPublished - Feb 2019


  • Hybrid imaging
  • Image guided therapy
  • Innovation
  • MRI
  • Myocardial viability imaging
  • Pre-clinical research
  • Predictive Value of Tests
  • Multimodal Imaging
  • Time Factors
  • Cardiac Catheterization/adverse effects
  • Female
  • Contrast Media/administration & dosage
  • Image Interpretation, Computer-Assisted/methods
  • Disease Models, Animal
  • Reproducibility of Results
  • Imaging, Three-Dimensional/methods
  • Myocardial Infarction/diagnostic imaging
  • Arrhythmias, Cardiac/etiology
  • Fluoroscopy
  • Coronary Angiography
  • Magnetic Resonance Imaging, Interventional/methods
  • Injections
  • Animals
  • Radiography, Interventional/methods
  • Software
  • Electrophysiologic Techniques, Cardiac
  • Sus scrofa


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