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Thibault B, Richer LP, McSpadden LC, Ryu K, Aguilar M, Cadrin-Tourigny J, Tadros R, Mondésert B, Rivard L, Dyrda K, Dubuc M, Macle L, Talajic M, Khairy P, Guerra PG, Roy D, Grégoire J, Harel F. Integration of 3D nuclear imaging in 3D mapping system for ventricular tachycardia ablation in patients with implanted devices: Perfusion/voltage retrospective assessment of scar location. Heart Rhythm O2 2022; 3:560-567. [PMID: 36340481 PMCID: PMC9626736 DOI: 10.1016/j.hroo.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The identification of low-voltage proarrhythmic areas for catheter ablation of scar-mediated ventricular tachycardia (VT) remains challenging. Integration of myocardial perfusion imaging (single-photon emission computed tomography/computed tomography; SPECT/CT) and electroanatomical mapping (EAM) may improve delineation of the arrhythmogenic substrate. Objective To assess the feasibility of SPECT/CT image integration with voltage maps using the EnSite Precision system (Abbott) in patients undergoing scar-mediated VT ablation. Methods Patients underwent SPECT/CT imaging prior to left ventricular (LV) EAM with the EnSite Precision mapping system. The SPECT/CT, EAM data, and ablation lesions were retrospectively co-registered in the EnSite Precision system and exported for analysis. Segmental tissue viability scores were calculated based on SPECT/CT perfusion and electrogram bipolar voltage amplitude. Concordance, specificity, and sensitivity between the 2 modalities as well as the impact of SPECT/CT spatial resolution were evaluated. Results Twenty subjects (95% male, 67 ± 7 years old, left ventricular ejection fraction 36% ± 11%) underwent EAM and SPECT/CT integration. A concordance of 70% was found between EAM and SPECT/CT for identification of cardiac segments as scar vs viable, with EAM showing a 68.5% sensitivity and 76.4% specificity when using SPECT/CT as a gold standard. Projection on low-resolution 3D geometries led to an average decrease of 38% ± 22% of the voltage points used. Conclusion The study demonstrated the feasibility of integrating SPECT/CT with EAM performed retrospectively for characterization of anatomical substrates during VT ablation procedures.
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Kudo T, Nessipkhan AE. Modalities for predicting events in patients with ICDs: Expanding the versatility of FDG PET. J Nucl Cardiol 2021; 28:478-480. [PMID: 33751471 DOI: 10.1007/s12350-021-02569-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Takashi Kudo
- Department of Radioisotope Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
| | - Arman Erzhanovich Nessipkhan
- Department of Radioisotope Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Jing R, Sun XX, Hua W, Chen L, Yang SW, Hu YR, Zhang NX, Cai MS, Gu M, Niu HX, Zhang S. Global and regional cardiac dysfunction quantified by 18F-FDG PET scans can predict ventricular arrhythmia in patients with implantable cardioverter defibrillator. J Nucl Cardiol 2021; 28:464-477. [PMID: 33751472 DOI: 10.1007/s12350-020-02515-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A low appropriate therapy rate indicates that a minority of patients will benefit from their implantable cardioverter defibrillator (ICD). Quantitative measurements from 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) may predict ventricular arrhythmia (VA) occurrence after ICD placement. METHODS We performed a prospective observational study and recruited patients who required ICD placement. Pre-procedure image scans were performed. Patients were followed up for VA occurrence. Associations between image results and VA were analyzed. RESULTS In 51 patients (33 males, 53.9 ± 17.2 years) analyzed, 17 (33.3%) developed VA. Compared with patients without VA, patients with VA had significantly larger values in scar area (17.7 ± 12.4% vs. 7.0 ± 7.9%), phase standard deviation (51.4° ± 14.0° vs. 34.0° ± 15.0°), bandwidth (172.9° ± 39.8° vs. 128.7° ± 49.9°), sum thickening score (STS, 29.5 ± 11.1 vs. 17.8 ± 13.2), and sum motion score (42.9 ± 11.5 vs. 33.0 ± 19.0). Cox regression analysis and receiver operating characteristic curve analysis showed that scar size, dyssynchrony, and STS were associated with VA occurrence (HR, 4.956, 95% CI 1.70-14.46). CONCLUSION Larger left ventricular scar burden, increased dyssynchrony, and higher STS quantified by 18F-FDG PET may indicate a higher VA incidence after ICD placement.
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Affiliation(s)
- Ran Jing
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xiao-Xin Sun
- Department of Nuclear Medicine, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Hua
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China.
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Sheng-Wen Yang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yi-Ran Hu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Ni-Xiao Zhang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Min-Si Cai
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Min Gu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Hong-Xia Niu
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, The Cardiac Arrhythmia Center, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, People's Republic of China
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Wan Ab Naim WN, Mokhtarudin MJM, Lim E, Chan BT, Ahmad Bakir A, Nik Mohamed NA. The study of border zone formation in ischemic heart using electro-chemical coupled computational model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3398. [PMID: 32857480 DOI: 10.1002/cnm.3398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Myocardial infarction (MI) is the most common cause of a heart failure, which occurs due to myocardial ischemia leading to left ventricular (LV) remodeling. LV remodeling particularly occurs at the ischemic area and the region surrounds it, known as the border zone. The role of the border zone in initiating LV remodeling process urges the investigation on the correlation between early border zone changes and remodeling outcome. Thus, this study aims to simulate a preliminary conceptual work of the border zone formation and evolution during onset of MI and its effect towards early LV remodeling processes by incorporating the oxygen concentration effect on the electrophysiology of an idealized three-dimensional LV through electro-chemical coupled mathematical model. The simulation result shows that the region of border zone, represented by the distribution of electrical conductivities, keeps expanding over time. Based on this result, the border zone is also proposed to consist of three sub-regions, namely mildly, moderately, and seriously impaired conductivity regions, which each region categorized depending on its electrical conductivities. This division could be used as a biomarker for classification of reversible and irreversible myocardial injury and will help to identify the different risks for the survival of patient. Larger ischemic size and complete occlusion of the coronary artery can be associated with an increased risk of developing irreversible injury, in particular if the reperfusion treatment is delayed. Increased irreversible injury area can be related with cardiovascular events and will further deteriorate the LV function over time.
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Affiliation(s)
- Wan N Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, Pekan, Malaysia
| | - Mohd J Mohamed Mokhtarudin
- Department of Mechanical Engineering, College of Engineering, University Malaysia Pahang, Kuantan, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee T Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham, Semenyih, Malaysia
| | - Azam Ahmad Bakir
- University of Southampton Malaysia Campus, Iskandar Puteri, Malaysia
| | - Nik A Nik Mohamed
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, Pekan, Malaysia
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Armstrong K, Larson C, Asfour H, Ransbury T, Sarvazyan N. A Percutaneous Catheter for In Vivo Hyperspectral Imaging of Cardiac Tissue: Challenges, Solutions and Future Directions. Cardiovasc Eng Technol 2020; 11:560-575. [PMID: 32666326 PMCID: PMC7530025 DOI: 10.1007/s13239-020-00476-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Multiple studies have shown that spectral analysis of tissue autofluorescence can be used as a live indicator for various pathophysiological states of cardiac tissue, including ischemia, ablation-induced damage, or scar formation. Yet today there are no percutaneous devices that can detect autofluorescence signals from inside a beating heart. Our aim was to develop a prototype catheter to demonstrate the feasibility of doing so. METHODS AND RESULTS Here we summarize technical solutions leading to the development of a percutaneous catheter capable of multispectral imaging of intracardiac surfaces. The process included several iterations of light sources, optical filtering, and image acquisition techniques. The developed system included a compliant balloon, 355 nm laser irradiance, a high-sensitivity CCD, bandpass filtering, and image acquisition synchronized with the cardiac cycle. It enabled us to capture autofluorescence images from multiple spectral bands within the visible range while illuminating the endocardial surface with ultraviolet light. Principal component analysis and other spectral unmixing post-processing algorithms were then used to reveal target tissue. CONCLUSION Based on the success of our prototype system, we are confident that the development of ever more sensitive cameras, recent advances in tunable filters, fiber bundles, and other optical and computational components makes it possible to create percutaneous catheters capable of acquiring hyper or multispectral hypercubes, including those based on autofluorescence, in real-time. This opens the door for widespread use of this methodology for high-resolution intraoperative imaging of internal tissues and organs-including cardiovascular applications.
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Affiliation(s)
- Kenneth Armstrong
- Nocturnal Product Development, LLC, 8128 Renaissance Pkwy #210, Durham, NC, 27713, USA.
| | - Cinnamon Larson
- Nocturnal Product Development, LLC, 8128 Renaissance Pkwy #210, Durham, NC, 27713, USA
| | - Huda Asfour
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street NW, Washington, DC, 20037, USA
| | - Terry Ransbury
- LuxMed Systems, Inc, 124 Country Drive, Weston, MA, 02493, USA
| | - Narine Sarvazyan
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street NW, Washington, DC, 20037, USA.
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Gräni C, Benz DC, Gupta S, Windecker S, Kwong RY. Sudden Cardiac Death in Ischemic Heart Disease. JACC Cardiovasc Imaging 2020; 13:2223-2238. [DOI: 10.1016/j.jcmg.2019.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022]
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Heidt T, Reiss S, Lottner T, Özen AC, Bode C, Bock M, von Zur Mühlen C. Magnetic resonance imaging for pathobiological assessment and interventional treatment of the coronary arteries. Eur Heart J Suppl 2020; 22:C46-C56. [PMID: 32368198 PMCID: PMC7189741 DOI: 10.1093/eurheartj/suaa009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
X-ray-based fluoroscopy is the standard tool for diagnostics and intervention in coronary artery disease. In recent years, computed tomography has emerged as a non-invasive alternative to coronary angiography offering detection of coronary calcification and imaging of the vessel lumen by the use of iodinated contrast agents. Even though currently available invasive or non-invasive techniques can show the degree of vessel stenosis, they are unable to provide information about biofunctional plaque properties, e.g. plaque inflammation. Furthermore, the use of radiation and the necessity of iodinated contrast agents remain unfavourable prerequisites. Magnetic resonance imaging (MRI) is a radiation-free alternative to X-ray which offers anatomical and functional imaging contrasts fostering the idea of non-invasive biofunctional assessment of the coronary vessel wall. In combination with molecular contrast agents that target-specific epitopes of the vessel wall, MRI might reveal unique plaque properties rendering it, for example, ‘vulnerable and prone to rupture’. Early detection of these lesions may allow for early or prophylactic treatment even before an adverse coronary event occurs. Besides diagnostic imaging, advances in real-time image acquisition and motion compensation now provide grounds for MRI-guided coronary interventions. In this article, we summarize our research on MRI-based molecular imaging in cardiovascular disease and feature our advances towards real-time MRI-based coronary interventions in a porcine model.
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Affiliation(s)
- Timo Heidt
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Simon Reiss
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Thomas Lottner
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Ali C Özen
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.,German Cancer Consortium Partner Site Freiburg, German Cancer Research Center (DKFZ), Stefan-Meier-Str. 17, 79104 Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Michael Bock
- Department of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology, Cardiology and Angiology I, Heart Center Freiburg University and Faculty of Medicine, Hugstetterstr. 55, 79106 Freiburg, Germany
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Rijnierse MT, van der Lingen ALCJ, de Haan S, Becker MAJ, Harms HJ, Huisman MC, Lammertsma AA, van de Ven PM, van Rossum AC, Knaapen P, Allaart CP. Value of CMR and PET in Predicting Ventricular Arrhythmias in Ischemic Cardiomyopathy Patients Eligible for ICD. JACC Cardiovasc Imaging 2020; 13:1755-1766. [PMID: 32305468 DOI: 10.1016/j.jcmg.2020.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study presents a head-to-head comparison of the value of cardiac magnetic resonance (CMR)-derived left-ventricular (LV) function and scar burden and positron emission tomography (PET)-derived perfusion and innervation in predicting ventricular arrhythmias (VAs). BACKGROUND Improved risk stratification of VA is important to identify patients who should benefit of prophylactic implantable cardioverter-defibrillator (ICD) implantation. Perfusion abnormalities, sympathetic denervation, and scar burden have all been linked to VA, although comparative studies are lacking. METHODS Seventy-four patients with ischemic cardiomyopathy and left-ventricular ejection fraction (LVEF) ≤35%, referred for primary prevention ICD placement were enrolled prospectively. Late gadolinium-enhanced (LGE) CMR was performed to assess LV function and scar characteristics. [15O]H2O and [11C]hydroxyephedrine positron emission tomography (PET) were performed to quantify resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR), and sympathetic innervation. During follow-up of 5.4 ± 1.9 years, the occurrence of sustained VA, appropriate ICD therapy, and mortality were evaluated. RESULTS In total, 20 (26%) patients experienced VA. CMR and PET parameters showed considerable overlap between patients with VA and patients without VA, caused by substantial heterogeneity within groups. Univariable analyses showed that lower LVEF (hazard ratio [HR]: 0.92; p = 0.03), higher left-ventricular end-diastolic volume index (LVEDVi) (HR 1.02; p < 0.01), and larger scar border zone (HR 1.11; p = 0.03) were related to VA. Scar core size, resting MBF, hyperemic MBF, perfusion defect size, innervation defect size, and the innervation-perfusion mismatch were not found to be associated with VA. CONCLUSIONS In patients with ischemic cardiomyopathy, lower LVEF, higher LVEDVi, and larger scar border zone were related to VA. PET-derived perfusion and sympathetic innervation, as well as CMR-derived scar core size were not associated with VA. These results suggest that improved prediction of VA by advanced imaging remains challenging for the individual patient.
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Affiliation(s)
- Mischa T Rijnierse
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Anne-Lotte C J van der Lingen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Stefan de Haan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marthe A J Becker
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Hendrik J Harms
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marc C Huisman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Popescu CE, Cuzzocrea M, Monaco L, Caobelli F. Assessment of myocardial sympathetic innervation by PET in patients with heart failure: a review of the most recent advances and future perspectives. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0293-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Swift LM, Asfour H, Muselimyan N, Larson C, Armstrong K, Sarvazyan NA. Hyperspectral imaging for label-free in vivo identification of myocardial scars and sites of radiofrequency ablation lesions. Heart Rhythm 2017; 15:564-575. [PMID: 29246829 DOI: 10.1016/j.hrthm.2017.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of cardiac arrhythmias often involves ablating viable muscle tissue within or near islands of scarred myocardium. Yet, today there are limited means by which the boundaries of such scars can be visualized during surgery and distinguished from the sites of acute injury caused by radiofrequency (RF) ablation. OBJECTIVE We sought to explore a hyperspectral imaging (HSI) methodology to delineate and distinguish scar tissue from tissue injury caused by RF ablation. METHODS RF ablation of the ventricular surface of live rats that underwent thoracotomy was followed by a 2-month animal recovery period. During a second surgery, new RF lesions were placed next to the scarred tissue from the previous ablation procedure. The myocardial infarction model was used as an alternative way to create scar tissue. RESULTS Excitation-emission matrices acquired from the sites of RF lesions, scar region, and the surrounding unablated tissue revealed multiple spectral changes. These findings justified HSI of the heart surface using illumination with 365 nm UV light while acquiring spectral images within the visible range. Autofluorescence-based HSI enabled to distinguish sites of RF lesions from scar or unablated myocardium in open-chest rats. A pilot version of a percutaneous HSI catheter was used to demonstrate the feasibility of RF lesion visualization in atrial tissue of live pigs. CONCLUSION HSI based on changes in tissue autofluorescence is a highly effective tool for revealing-in vivo and with high spatial resolution-surface boundaries of myocardial scar and discriminating it from areas of acute necrosis caused by RF ablation.
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Affiliation(s)
- Luther M Swift
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Huda Asfour
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Narine Muselimyan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | | | - Narine A Sarvazyan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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