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Mehta NK, Haines DE. Is Seeing Believing? Adding Another Tool to Assess PFA Durability. Circ Arrhythm Electrophysiol 2024; 17:e012773. [PMID: 38426304 DOI: 10.1161/circep.124.012773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Nishaki Kiran Mehta
- Department of Cardiovascular Medicine, Corewell William Beaumont University Hospital, Royal Oak, MI
| | - David E Haines
- Department of Cardiovascular Medicine, Corewell William Beaumont University Hospital, Royal Oak, MI
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Terricabras M, Martins RP, Peinado R, Derejko P, Mont L, Ernst S, Herranz D, Bailleul C, Verma A. Cardiac Pulsed Field Ablation Lesion Durability Assessed by Polarization-Sensitive Optical Coherence Reflectometry. Circ Arrhythm Electrophysiol 2024; 17:e012255. [PMID: 38318720 PMCID: PMC10949975 DOI: 10.1161/circep.123.012255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pulsed field ablation uses electrical fields to cause nonthermal cell death over several hours. Polarization-sensitive optical coherence reflectometry is an optical imaging technique that can detect changes in the tissue ultrastructure in real time, which occurs when muscular tissue is damaged. The objective of this study was to evaluate the ability of a polarization-sensitive optical coherence reflectometry system to predict the development of chronic lesions based on acute changes in tissue birefringence during pulsed field ablation. METHODS Superior vena cava isolation was performed in 30 swine using a biphasic, bipolar pulsed field ablation system delivered with a nonirrigated focal tip catheter. Acute changes in tissue birefringence and voltage abatement were analyzed for each individual lesion. A high-resolution electroanatomical map was performed at baseline and 4 to 12 weeks after ablation to locate electrical gaps in the ablated area. RESULTS A total of 141 lesions were delivered and included in the analysis. Acute electrical isolation based on the electroanatomical map was achieved in 96% of the animals, but chronic isolation was only seen in 14 animals (46%). The mean voltage abatement of lesions that showed recovery was 82.8%±14.6% versus 84.4%±17.4% for those that showed fibrosis (P=0.7). The mean acute reduction in tissue birefringence in points demonstrating fibrosis was 63.8%±11.3% versus 9.1%±0.1% in the points that resulted in electrical gaps. A threshold of acute reduction of birefringence of ≥20% could predict chronic lesion formation with a sensitivity of 96% and a specificity of 83%. CONCLUSIONS Acute tissue birefringence changes assessed with polarization-sensitive optical coherence reflectometry during pulsed field ablation can predict chronic lesion formation and guide the ablation procedure although limited by the tissue thickness.
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Affiliation(s)
- Maria Terricabras
- Sunnybrook Research Institute, University of Toronto, ON, Canada (M.T.)
| | - Raphael P Martins
- Centre Hospitalier Universitaire de Rennes, Centres d'Investigation Clinique - Innovation Technologique (CIC-IT), Laboratoire Traitement du Signal et de l'Image Institut National de la Santé et de la Recherche Médicale (LTSI INSERM) 1099, University of Rennes, France (R.P.M.)
| | - Rafael Peinado
- University Hospital La Paz, Autonomous University of Madrid, Spain (R.P.)
| | | | - Lluís Mont
- Hospital Clínic, Universitat de Barcelona, Spain (L.M.)
- Instituto de Investigaciones Biomèdicas August Pi i Sunyer, Barcelona, Spain (L.M.)
- Centro de Investigación en Red Cardiovascular, Madrid, Spain (L.M.)
| | - Sabine Ernst
- Royal Brompton Hospital, Imperial College London, United Kingdom (S.E.)
| | | | | | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, QC, Canada (A.V.)
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Bhatti HS, Khan S, Zahra M, Mustafa S, Ashraf S, Ahmad I. Characterization of radiofrequency ablated myocardium with optical coherence tomography. Photodiagnosis Photodyn Ther 2022; 40:103151. [PMID: 36228980 DOI: 10.1016/j.pdpdt.2022.103151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
Certain types of cardiac arrhythmias are best treated with radiofrequency (RF) ablation, in which an electrode is inserted into the targeted area of the myocardium and then RF electrical current is applied to heat and destroy surrounding tissue. The resulting ablation lesion usually consists of a coagulative necrotic core surrounded by a rim region of mixed viable and non-viable cells. The characterization of the RF ablated lesion is of potential clinical importance. Here we aim to elaborate optical coherence tomography (OCT) imaging for the characterization of RF-ablated myocardial tissue. In particular, the underlying principles of OCT and its polarization-sensitive counterpart (PS-OCT) are presented, followed by the knowledge needed to interpret their optical images. Studies focused on real-time monitoring of RF lesion formation in the myocardium using OCT systems are summarized. The design and development of various hybrid probes incorporating both OCT guidance and RF ablation catheters are also discussed. Finally, the challenges related to the transmission of OCT imaging systems to cardiac clinics for real-time monitoring of RF lesions are outlined.
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Affiliation(s)
| | - Shamim Khan
- Department of Physics, Islamia College Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Madeeha Zahra
- Department of Physics, The Women University Multan, Pakistan
| | - Sonia Mustafa
- Department of Physics, The Women University Multan, Pakistan
| | - Sumara Ashraf
- Department of Physics, The Women University Multan, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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González-Suárez A, Pérez JJ, Irastorza RM, D'Avila A, Berjano E. Computer modeling of radiofrequency cardiac ablation: 30 years of bioengineering research. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 214:106546. [PMID: 34844766 DOI: 10.1016/j.cmpb.2021.106546] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
This review begins with a rationale of the importance of theoretical, mathematical and computational models for radiofrequency (RF) catheter ablation (RFCA). We then describe the historical context in which each model was developed, its contribution to the knowledge of the physics of RFCA and its implications for clinical practice. Next, we review the computer modeling studies intended to improve our knowledge of the biophysics of RFCA and those intended to explore new technologies. We describe the most important technical details of the implementation of mathematical models, including governing equations, tissue properties, boundary conditions, etc. We discuss the utility of lumped element models, which despite their simplicity are widely used by clinical researchers to provide a physical explanation of how RF power is absorbed in different tissues. Computer model verification and validation are also discussed in the context of RFCA. The article ends with a section on the current limitations, i.e. aspects not yet included in state-of-the-art RFCA computer modeling and on future work aimed at covering the current gaps.
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Affiliation(s)
- Ana González-Suárez
- Electrical and Electronic Engineering, National University of Ireland Galway, Ireland; Translational Medical Device Lab, National University of Ireland Galway, Ireland
| | - Juan J Pérez
- Department of Electronic Engineering, BioMIT, Universitat Politècnica de València, Valencia, Spain
| | - Ramiro M Irastorza
- Instituto de Física de Líquidos y Sistemas Biológicos (CONICET), La Plata, Argentina; Instituto de Ingeniería y Agronomía, Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Andre D'Avila
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Enrique Berjano
- Department of Electronic Engineering, BioMIT, Universitat Politècnica de València, Valencia, Spain.
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Zhao X, Ziv O, Mohammadpour R, Crosby B, Hoyt WJ, Jenkins MW, Snyder C, Hendon C, Laurita KR, Rollins AM. Polarization-sensitive optical coherence tomography monitoring of percutaneous radiofrequency ablation in left atrium of living swine. Sci Rep 2021; 11:24330. [PMID: 34934120 PMCID: PMC8692484 DOI: 10.1038/s41598-021-03724-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/06/2021] [Indexed: 11/12/2022] Open
Abstract
Radiofrequency ablation (RFA) is commonly used to treat atrial fibrillation (AF). However, the outcome is often compromised due to the lack of direct real-time feedback to assess lesion transmurality. In this work, we evaluated the ability of polarization-sensitive optical coherence tomography (PSOCT) to measure cardiac wall thickness and assess RF lesion transmurality during left atrium (LA) RFA procedures. Quantitative transmural lesion criteria using PSOCT images were determined ex vivo using an integrated PSOCT-RFA catheter and fresh swine hearts. LA wall thickness of living swine was measured with PSOCT and validated with a micrometer after harvesting the heart. A total of 38 point lesions were created in the LA of 5 living swine with the integrated PSOCT-RFA catheter using standard clinical RFA procedures. For all lesions with analyzable PSOCT images, lesion transmurality was assessed with a sensitivity of 89% (17 of 19 tested positive) and a specificity of 100% (5 of 5 tested negative) using the quantitative transmural criteria. This is the first report of using PSOCT to assess LA RFA lesion transmurality in vivo. The results indicate that PSOCT may potentially provide direct real-time feedback for LA wall thickness and lesion transmurality.
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Affiliation(s)
- Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Ohad Ziv
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Heart and Vascular Research Center, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Benjamin Crosby
- Department of Chemistry, Case Western Reserve University, Cleveland, OH, USA
| | - Walter J Hoyt
- Department of Pediatrics, Ochsner Health, New Orleans, LA, USA
| | - Michael W Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher Snyder
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- The Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, USA
| | - Kenneth R Laurita
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- Heart and Vascular Research Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Pérez JJ, González-Suárez A, Nadal E, Berjano E. Thermal impact of replacing constant voltage by low-frequency sine wave voltage in RF ablation computer modeling. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 195:105673. [PMID: 32750633 DOI: 10.1016/j.cmpb.2020.105673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES A constant voltage (DC voltage) is usually used in radiofrequency ablation (RFA) computer models to mimic the radiofrequency voltage. However, in some cases a low frequency sine wave voltage (AC voltage) may be used instead. Our objective was to assess the thermal impact of replacing DC voltage by low-frequency AC voltage in RFA computer modeling. METHODS A 2D model was used consisting of an ablation electrode placed perpendicular to the tissue fragment. The Finite Element method was used to solve a coupled electric-thermal problem. Quasi-static electrical approximation was implemented in two ways (both with equivalent electrical power): (1) by a constant voltage of 25 V in the ablation electrode (DC voltage), and (2) applying a sine waveform with peak amplitude of 25√2 V (AC voltage). The frequency of the sine signal (fAC) varied from 0.5 Hz to 50 Hz. RESULTS Sine wave thermal oscillations (at twice the fAC frequency) were observed in the case of AC voltage, in addition to the temperature obtained by DC voltage. The amplitude of the oscillations: (1) increased with temperature, remaining more or less constant after 30 s; (2) was of up to ±3 °C for very low fAC values (0.5 Hz); and (3) was reduced at higher fAC values and with distance from the electrode (almost negligible for distances > 5 mm). The evolution of maximum lesion depth and width were almost identical with both DC and AC. CONCLUSIONS Although reducing fAC reduces the computation time, thermal oscillations appear at points near the electrode, which suggests that a minimum value of fAC should be used. Replacing DC voltage by low-frequency AC voltage does not appear to have an impact on the lesion depth.
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Affiliation(s)
- Juan J Pérez
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Electrical and Electronic Engineering, National University of Ireland Galway, Ireland; Translational Medical Device Lab, National University of Ireland Galway, Ireland
| | - Enrique Nadal
- Centro de Investigación en Ingeniería Mecánica, Universitat Politècnica de València, Valencia, Spain
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain.
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Park S, Hwang J, Park JE, Ahn YC, Kang HW. Application of Ultrasound Thermal Imaging for Monitoring Laser Ablation in Ex Vivo Cardiac Tissue. Lasers Surg Med 2019; 52:218-227. [PMID: 31493345 DOI: 10.1002/lsm.23157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Laser ablation can be used to treat atrial fibrillation by thermally isolating pulmonary veins. In this study, we evaluated the feasibility of high-resolution (<1 mm) ultrasound thermal imaging to monitor spatial temperature distribution during laser ablation on ex vivo cardiac tissue. STUDY DESIGN/MATERIALS AND METHODS Laser ablation (808 nm) was performed on five porcine cardiac tissue samples. A thermocouple was used to measure the interstitial tissue temperature during the laser ablation process. Tissue-strain-based ultrasound thermal imaging was conducted to monitor the spatial distribution of the temperature in the cardiac tissue. The tissue temperature was estimated from the time shifts of ultrasound signals owing to the changes in the speed of sound and was compared with the measured temperature. The temperature estimation coefficient k of porcine cardiac tissue was calculated from the estimated thermal strain and the measured temperature. The degree of tissue coagulation (temperatures > 50°C) was derived from the estimated temperature and was compared with that of the tested cardiac tissue. RESULTS The estimated tissue temperature using strain-based ultrasound thermal imaging at a depth of 1 mm agreed with thermocouple measurements. During the 30-second period of the laser ablation process, the estimated tissue temperature increased from 25 to 70°C at a depth of 0.1 mm, while the estimated temperature at a depth of 1 mm increased up to 46°C. Owing to the uncertainty of the coefficient k, the k value of the porcine cardiac tissue varied from 160 to 220°C with temperature changes of up to 20°C. The estimated coagulation region in the ultrasound thermal imaging was 20% wider (+0.6 mm) but 9% shallower (-0.1 mm) than the measured region of the ablated porcine cardiac tissue. CONCLUSIONS The current study demonstrated the feasibility of temperature monitoring with the use of ultrasound thermal imaging during the laser ablation on ex vivo porcine cardiac tissue. The high-resolution ultrasound thermal imaging could map the spatial distribution of the tissue temperature. The proposed method can be used to monitor the temperature and thermal coagulation to achieve effective laser ablation for atrial fibrillation. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Suhyun Park
- School of Electrical and Electronics Engineering, Chung-Ang University, Seoul, 06974, South Korea
| | - Jieun Hwang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, 48513, South Korea
| | - Jung-Eun Park
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, 48513, South Korea
| | - Yeh-Chan Ahn
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, 48513, South Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Busan, 48513, South Korea
| | - Hyun Wook Kang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, 48513, South Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Busan, 48513, South Korea
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Zhao X, Fu X, Blumenthal C, Wang YT, Jenkins MW, Snyder C, Arruda M, Rollins AM. Integrated RFA/PSOCT catheter for real-time guidance of cardiac radio-frequency ablation. BIOMEDICAL OPTICS EXPRESS 2018; 9:6400-6411. [PMID: 31065438 PMCID: PMC6490984 DOI: 10.1364/boe.9.006400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 05/21/2023]
Abstract
Radiofrequency ablation (RFA) is an important standard therapy for cardiac arrhythmias, but direct monitoring of tissue treatment is currently lacking. We demonstrate an RFA catheter integrated with polarization sensitive optical coherence tomography (PSOCT) for directly monitoring the RFA process in real time. The integrated RFA/OCT catheter was modified from a standard clinical RFA catheter and includes a miniature forward-viewing cone-scanning OCT probe. The PSOCT system was validated with a quarter-wave plate while the RFA function of the integrated catheter was validated by comparing lesion sizes with those made with an unmodified RFA catheter. Additionally, the integrated catheter guided catheter-tissue apposition and monitored RFA lesion formation in cardiac tissue in real time. The results show that catheter-tissue contact can be characterized by observing the features of the blood and tissue in the acquired OCT images and that RFA lesion formation can be confirmed by monitoring the change in phase retardance in the acquired PSOCT images. This system demonstrates the feasibility of an integrated RFA/OCT catheter to deliver RF energy and image the cardiac wall simultaneously and justifies further research into use of this technology to aid RFA therapy for cardiac arrhythmias.
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Affiliation(s)
- Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- authors contributed equally
| | - Xiaoyong Fu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- authors contributed equally
| | - Colin Blumenthal
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Yves T. Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Christopher Snyder
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
- Rainbow Babies and Children’s Hospital, Division of Pediatric Cardiology, University Hospitals, Cleveland, OH 44106, USA
| | - Mauricio Arruda
- Department of Cardiology, University Hospitals Case Medical Center, Cleveland, OH 44120, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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