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Haines DE. What is Different About Pulsed Field Ablation … Everything? J Cardiovasc Electrophysiol 2022; 33:368-370. [PMID: 35005815 DOI: 10.1111/jce.15353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
From the time of early preclinical reports of the efficacy, speed and safety of pulsed field ablation (PFA), the interventional electrophysiology community has been waiting in anxious anticipation for its clinical approval and release. As most people actively engaged in interventional electrophysiology know, PFA is the technology that creates myocardial lesions with trains of very high voltage pulses that are nanoseconds or microseconds in duration1 . This form of ablation is nonthermal, and cell injury/death is created by electroporation of the organelles and sarcolemmal membrane, with cell death occurring via apoptosis as well as other mechanisms2 .
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Affiliation(s)
- David E Haines
- Beaumont Health System, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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2
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Cooper BL, Gloschat C, Swift LM, Prudencio T, McCullough D, Jaimes R, Posnack NG. KairoSight: Open-Source Software for the Analysis of Cardiac Optical Data Collected From Multiple Species. Front Physiol 2021; 12:752940. [PMID: 34777017 PMCID: PMC8586513 DOI: 10.3389/fphys.2021.752940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiac optical mapping, also known as optocardiography, employs parameter-sensitive fluorescence dye(s) to image cardiac tissue and resolve the electrical and calcium oscillations that underly cardiac function. This technique is increasingly being used in conjunction with, or even as a replacement for, traditional electrocardiography. Over the last several decades, optical mapping has matured into a “gold standard” for cardiac research applications, yet the analysis of optical signals can be challenging. Despite the refinement of software tools and algorithms, significant programming expertise is often required to analyze large optical data sets, and data analysis can be laborious and time-consuming. To address this challenge, we developed an accessible, open-source software script that is untethered from any subscription-based programming language. The described software, written in python, is aptly named “KairoSight” in reference to the Greek word for “opportune time” (Kairos) and the ability to “see” voltage and calcium signals acquired from cardiac tissue. To demonstrate analysis features and highlight species differences, we employed experimental datasets collected from mammalian hearts (Langendorff-perfused rat, guinea pig, and swine) dyed with RH237 (transmembrane voltage) and Rhod-2, AM (intracellular calcium), as well as human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) dyed with FluoVolt (membrane potential), and Fluo-4, AM (calcium indicator). We also demonstrate cardiac responsiveness to ryanodine (ryanodine receptor modulator) and isoproterenol (beta-adrenergic agonist) and highlight regional differences after an ablation injury. KairoSight can be employed by both basic and clinical scientists to analyze complex cardiac optical mapping datasets without requiring dedicated computer science expertise or proprietary software.
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Affiliation(s)
- Blake L Cooper
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology and Physiology, George Washington University, Washington, DC, United States
| | - Chris Gloschat
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Luther M Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Tomas Prudencio
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Damon McCullough
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Rafael Jaimes
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States
| | - Nikki G Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States.,Children's National Heart Institute, Children's National Hospital, Washington, DC, United States.,Department of Pharmacology and Physiology, George Washington University, Washington, DC, United States.,Department of Pediatrics, George Washington University, Washington, DC, United States
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3
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Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol 2020; 18:210-225. [PMID: 33051613 DOI: 10.1038/s41569-020-00451-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation for atrial fibrillation (AF) has emerged as an important rhythm-control strategy and is by far the most common cardiac ablation procedure performed worldwide. Current guidelines recommend the procedure in symptomatic patients with paroxysmal or persistent AF who are refractory or intolerant to antiarrhythmic drugs. The procedure might also be considered as a first-line approach in selected asymptomatic patients. Data from large registries indicate that AF ablation might reduce mortality and the risk of heart failure and stroke, but evidence from randomized controlled trials is mixed. Pulmonary vein isolation using point-by-point radiofrequency or with the cryoballoon remains the cornerstone technique in AF ablation. Additional atrial ablation can be performed in patients with persistent AF, but its benefits are largely unproven. Technological advances in the past decade have focused on achieving durable vein isolation, reducing procedure duration and improving safety. Numerous exciting new technologies are in various stages of development. In this Review, we discuss the relevant data to support the recommended and evolving indications for catheter ablation of AF, describe the different ablation techniques, and highlight the latest advances in technology that aim to improve its safety and efficacy. We also discuss lifestyle modification strategies to improve ablation outcomes.
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Affiliation(s)
- Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ahmed M Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
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Asfour H, Otridge J, Thomasian R, Larson C, Sarvazyan N. Autofluorescence properties of balloon polymers used in medical applications. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200216R. [PMID: 33084257 PMCID: PMC7575097 DOI: 10.1117/1.jbo.25.10.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
SIGNIFICANCE For use in medical balloons and related clinical applications, polymers are usually designed for transparency under illumination with white-light sources. However, when illuminated with ultraviolet (UV) or blue light, most of these materials autofluoresce in the visible range, which can be a concern for modalities that rely on tissue autofluorescence for diagnostic or therapeutic purposes. AIM A search for published information on spectral properties of polymers that can be used for medical balloon manufacturing revealed a scarcity of published information on this subject. The aim of these studies was to address this gap. APPROACH The autofluorescence properties of polymers used in medical balloon manufacturing were examined for their suitability for hyperspectral imaging and related applications. Excitation-emission matrices of different balloon materials were acquired within the 320- to 620-nm spectral range. In parallel, autofluorescence profiles from the 420- to 620-nm range were extracted from hyperspectral datasets of the same samples illuminated with UV light. The list of tested polymers included polyurethanes, nylon, polyethylene terephthalate (PET), polyether block amide (PEBAX), vulcanized silicone, thermoplastic elastomers with and without talc, and cyclic olefin copolymers, known by their trade name TOPAS. RESULTS Each type of polymer exhibited a specific pattern of autofluorescence. Polyurethanes, PET, and thermoplastic elastomers containing talc had the highest autofluorescence values, while sheets made of nylon, PEBAX, and TOPAS exhibited negligible autofluorescence. Hyperspectral imaging was used to illustrate how the choice of specific balloon material can impact the ability of principal component analysis to reveal the ablated cardiac tissue. CONCLUSIONS The data revealed significant differences between autofluorescence profiles of the polymers and pointed to the most promising balloon materials for clinical implementation of approaches that depend on tissue autofluorescence.
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Affiliation(s)
- Huda Asfour
- The George Washington University, Department of Pharmacology and Physiology, Washington, DC, United States
| | - Jeremy Otridge
- The George Washington University, Department of Pharmacology and Physiology, Washington, DC, United States
| | - Robert Thomasian
- The George Washington University, Department of Pharmacology and Physiology, Washington, DC, United States
| | - Cinnamon Larson
- Nocturnal Product Development, LLC, Durham, North Carolina, United States
| | - Narine Sarvazyan
- The George Washington University, Department of Pharmacology and Physiology, Washington, DC, United States
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5
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Key factors behind autofluorescence changes caused by ablation of cardiac tissue. Sci Rep 2020; 10:15369. [PMID: 32958843 PMCID: PMC7506017 DOI: 10.1038/s41598-020-72351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
Radiofrequency ablation is a commonly used clinical procedure that destroys arrhythmogenic sources in patients suffering from atrial fibrillation and other types of cardiac arrhythmias. To improve the success of this procedure, new approaches for real-time visualization of ablation sites are being developed. One of these promising methods is hyperspectral imaging, an approach that detects lesions based on changes in the endogenous tissue autofluorescence profile. To facilitate the clinical implementation of this approach, we examined the key variables that can influence ablation-induced spectral changes, including the drop in myocardial NADH levels, the release of lipofuscin-like pigments, and the increase in diffuse reflectance of the cardiac muscle beneath the endocardial layer. Insights from these experiments suggested simpler algorithms that can be used to acquire and post-process the spectral information required to reveal the lesion sites. Our study is relevant to a growing number of multilayered clinical targets to which spectral approaches are being applied.
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Guttman MA, Tao S, Fink S, Tunin R, Schmidt EJ, Herzka DA, Halperin HR, Kolandaivelu A. Acute enhancement of necrotic radio-frequency ablation lesions in left atrium and pulmonary vein ostia in swine model with non-contrast-enhanced T 1 -weighted MRI. Magn Reson Med 2020; 83:1368-1379. [PMID: 31565818 PMCID: PMC6949368 DOI: 10.1002/mrm.28001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate non-contrast-enhanced MRI of acute radio-frequency ablation (RFA) lesions in the left atrium (LA) and pulmonary vein (PV) ostia. The goal is to provide a method for discrimination between necrotic (permanent) lesions and reversible injury, which is associated with recurrence after treatment of atrial fibrillation. METHODS Fifteen normal swine underwent RFA around the right-superior PV ostia. Electrical pulmonary vein isolation (PVI) was verified by electro-anatomic mapping (EAM) and pacing. MRI was carried out using a 3D respiratory-gated T1 -weighted long inversion time (TWILITE) sequence without contrast agent. Key settings were: inversion time 700 ms, triggering over 2 cardiac cycles, pixel size 1.1 mm3 . Contrast-enhanced imaging and T2 -weighted imaging were carried out for comparison. Six animals were sacrificed on ablation day for TTC-stained gross pathology, 9 animals were sacrificed after 2-3 mo after repeat EAM and MRI. Image intensity ratio (IIR) was used to measure lesion enhancement, and gross pathology was used to validate image enhancement patterns and compare lesion widths. RESULTS RFA lesions exhibited unambiguous enhancement in acute TWILITE imaging (IIR = 2.34 ± 0.49 at 1.5T), and the enhancement patterns corresponded well with gross pathology. Lesion widths in MRI correlated well with gross pathology (R2 = 0.84), with slight underestimation by 0.9 ± 0.5 mm. Lesion enhancement subsided chronically. CONCLUSION TWILITE imaging allowed acute detection of permanent RFA lesions in swine LA and PV ostia, without the need for contrast agent. Lesion enhancement pattern showed good correspondence to gross pathology and was well visualized by volume rendering. This method may provide valuable intra- or post-procedural assessment of RFA treatment.
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Affiliation(s)
- Michael A Guttman
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Susumu Tao
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Fink
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rick Tunin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ehud J Schmidt
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Daniel A Herzka
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry R Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Aravindan Kolandaivelu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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7
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Singh-Moon RP, Yao X, Iyer V, Marboe C, Whang W, Hendon CP. Real-time optical spectroscopic monitoring of nonirrigated lesion progression within atrial and ventricular tissues. JOURNAL OF BIOPHOTONICS 2019; 12:e201800144. [PMID: 30058239 PMCID: PMC6353711 DOI: 10.1002/jbio.201800144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 05/24/2023]
Abstract
Despite considerable advances in guidance of radiofrequency ablation (RFA) therapy for the treatment of cardiac arrhythmias, success rates have been hampered by a lack of tools for precise intraoperative evaluation of lesion extent. Near-infrared spectroscopic (NIRS) techniques are sensitive to tissue structural and biomolecular properties, characteristics that are directly altered by radiofrequency (RF) treatment. In this work, a combined NIRS-RFA catheter is developed for real-time monitoring of tissue reflectance during RF energy delivery. An algorithm is proposed for processing NIR spectra to approximate nonirrigated lesion depth in both atrial and ventricular tissues. The probe optical geometry was designed to bias measurement influence toward absorption enabling enhanced sensitivity to changes in tissue composition. A set of parameters termed "lesion optical indices" are defined encapsulating spectral differences between ablated and unablated tissue. Utilizing these features, a model for real-time tissue spectra classification and lesion size estimation is presented. Experimental validation conducted within freshly excised porcine cardiac specimens showed strong concordance between algorithm estimates and post-hoc tissue assessment.
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Affiliation(s)
- Rajinder P. Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
| | - Xinwen Yao
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
| | - Vivek Iyer
- Department of Medicine, Cardiology Division, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
| | - Charles Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
| | - William Whang
- Department of Medicine, Cardiology Division, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
- Currently with Department of Medicine, Cardiology Division, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
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Barkagan M, Rottmann M, Leshem E, Shen C, Buxton AE, Anter E. Effect of Baseline Impedance on Ablation Lesion Dimensions. Circ Arrhythm Electrophysiol 2018; 11:e006690. [DOI: 10.1161/circep.118.006690] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Barkagan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Boston, MA (M.B., M.R., E.L., A.E.B., E.A.)
| | - Markus Rottmann
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Boston, MA (M.B., M.R., E.L., A.E.B., E.A.)
| | - Eran Leshem
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Boston, MA (M.B., M.R., E.L., A.E.B., E.A.)
| | - Changyu Shen
- Division of Cardiovascular Medicine, Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA (C.S.)
| | - Alfred E. Buxton
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Boston, MA (M.B., M.R., E.L., A.E.B., E.A.)
| | - Elad Anter
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard-Thorndike Electrophysiology Institute, Harvard Medical School, Boston, MA (M.B., M.R., E.L., A.E.B., E.A.)
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9
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Asfour H, Guan S, Muselimyan N, Swift L, Loew M, Sarvazyan N. Optimization of wavelength selection for multispectral image acquisition: a case study of atrial ablation lesions. BIOMEDICAL OPTICS EXPRESS 2018; 9:2189-2204. [PMID: 29760980 PMCID: PMC5946781 DOI: 10.1364/boe.9.002189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/08/2018] [Accepted: 04/09/2018] [Indexed: 05/17/2023]
Abstract
In vivo autofluorescence hyperspectral imaging of moving objects can be challenging due to motion artifacts and to the limited amount of acquired photons. To address both limitations, we selectively reduced the number of spectral bands while maintaining accurate target identification. Several downsampling approaches were applied to data obtained from the atrial tissue of adult pigs with sites of radiofrequency ablation lesions. Standard image qualifiers such as the mean square error, the peak signal-to-noise ratio, the structural similarity index map, and an accuracy index of lesion component images were used to quantify the effects of spectral binning, an increased spectral distance between individual bands, as well as random combinations of spectral bands. Results point to several quantitative strategies for deriving combinations of a small number of spectral bands that can successfully detect target tissue. Insights from our studies can be applied to a wide range of applications.
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Affiliation(s)
- Huda Asfour
- Department of Pharmacology & Physiology, The George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA
| | - Shuyue Guan
- Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
| | - Narine Muselimyan
- Department of Pharmacology & Physiology, The George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA
| | - Luther Swift
- Department of Pharmacology & Physiology, The George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA
| | - Murray Loew
- Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
| | - Narine Sarvazyan
- Department of Pharmacology & Physiology, The George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA
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10
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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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11
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Haines DE, Wright M, Harks E, Deladi S, Fokkenrood S, Brink R, Belt H, Kolen AF, Mihajlovic N, Zuo F, Rankin D, Stoffregen W, Cockayne D, Cefalu J. Near-Field Ultrasound Imaging During Radiofrequency Catheter Ablation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005295. [DOI: 10.1161/circep.117.005295] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022]
Affiliation(s)
- David E. Haines
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Matthew Wright
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Erik Harks
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Szabolcs Deladi
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Steven Fokkenrood
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Rob Brink
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Harm Belt
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Alexander F. Kolen
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Nenad Mihajlovic
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Fei Zuo
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Darrell Rankin
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - William Stoffregen
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Debra Cockayne
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
| | - Joseph Cefalu
- From the Department of Cardiovascular Medicine, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.,); St. Thomas’ Hospital, London, United Kingdom (M.W.); Philips Healthcare, Best, The Netherlands (E.H., S.D., S.F., R.B.); Philips Research, Eindhoven, The Netherlands (H.B., A.F.K., N.M., F.Z.); and Boston Scientific Co. Inc, San Jose, CA (D.R., W.S., D.C., J.C.)
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Melby DP. Catheter Ablation of Atrial Fibrillation: A Review of the Current Status and Future Directions. J Innov Card Rhythm Manag 2017; 8:2907-2917. [PMID: 32477760 PMCID: PMC7252758 DOI: 10.19102/icrm.2017.081101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/19/2017] [Indexed: 11/20/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias encountered in clinical practice today. Over the last 20 years, the frequency of use of catheter ablation to treat AF has grown, commensurate with the rise in arrhythmia burden and via a number of technical advancements. These developments can be divided into new techniques for myocardial ablation, improvements in the understanding of AF trigger mechanisms, and advancements in atrial mapping. Progress in these fields has led to a fundamental change in daily practice, and has contributed to a rise, for ablation, from a procedure performed infrequently at select centers to one that is commonplace worldwide. In this article, the data and methods leading to this fundamental change will be presented and discussed.
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Affiliation(s)
- Daniel P Melby
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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Muselimyan N, Jishi MA, Asfour H, Swift L, Sarvazyan NA. Anatomical and Optical Properties of Atrial Tissue: Search for a Suitable Animal Model. Cardiovasc Eng Technol 2017; 8:505-514. [PMID: 28884368 DOI: 10.1007/s13239-017-0329-7] [Citation(s) in RCA: 7] [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: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to evaluate structural and optical properties of atrial tissue from common animal models and to compare it with human atria. We aimed to do this in a format that will be useful for development of better ablation tools and/or new means for visualizing atrial lesions. Human atrial tissue from clinically relevant age group was compared and contrasted with atrial tissue of large animal models commonly available for research purposes. These included pigs, sheep, dogs and cows. The presented data include area measurements of smooth atrial surface available for ablation and estimates of thickness of collagen and muscle for five different species. We also described methods to quantify presence of collagen and overall thickness of atrial wall. Provided information enables placement of atrial lesions to locations with clinically relevant atrial wall thickness and macroscopic structure ultimately helping investigators to develop better ablation and imaging tools. It also highlights the impact of collagen thickness on optical measurements and lesion visualization.
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Affiliation(s)
- Narine Muselimyan
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington, DC, 20052, USA
| | - Mohammed Al Jishi
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington, DC, 20052, USA
| | - Huda Asfour
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington, DC, 20052, USA
| | - Luther Swift
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington, DC, 20052, USA
| | - Narine A Sarvazyan
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington, DC, 20052, USA.
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Gil DA, Swift LM, Asfour H, Muselimyan N, Mercader MA, Sarvazyan NA. Autofluorescence hyperspectral imaging of radiofrequency ablation lesions in porcine cardiac tissue. JOURNAL OF BIOPHOTONICS 2017; 10:1008-1017. [PMID: 27545317 PMCID: PMC5511096 DOI: 10.1002/jbio.201600071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/21/2016] [Accepted: 07/29/2016] [Indexed: 05/22/2023]
Abstract
Radiofrequency ablation (RFA) is a widely used treatment for atrial fibrillation, the most common cardiac arrhythmia. Here, we explore autofluorescence hyperspectral imaging (aHSI) as a method to visualize RFA lesions and interlesional gaps in the highly collagenous left atrium. RFA lesions made on the endocardial surface of freshly excised porcine left atrial tissue were illuminated by UV light (365 nm), and hyperspectral datacubes were acquired over the visible range (420-720 nm). Linear unmixing was used to delineate RFA lesions from surrounding tissue, and lesion diameters derived from unmixed component images were quantitatively compared to gross pathology. RFA caused two consistent changes in the autofluorescence emission profile: a decrease at wavelengths below 490 nm (ascribed to a loss of endogenous NADH) and an increase at wavelengths above 490 nm (ascribed to increased scattering). These spectral changes enabled high resolution, in situ delineation of RFA lesion boundaries without the need for additional staining or exogenous markers. Our results confirm the feasibility of using aHSI to visualize RFA lesions at clinically relevant locations. If integrated into a percutaneous visualization catheter, aHSI would enable widefield optical surgical guidance during RFA procedures and could improve patient outcome by reducing atrial fibrillation recurrence.
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Affiliation(s)
- Daniel A. Gil
- Department of Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington DC, USA
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, PMB 351631, 2301 Vanderbilt Place, Nashville, TN, USA
| | - Luther M. Swift
- Department of Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington DC, USA
| | - Huda Asfour
- Department of Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington DC, USA
| | - Narine Muselimyan
- Department of Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington DC, USA
| | - Marco A. Mercader
- Division of Cardiology, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue NW, Suite 4-417, Washington DC, USA
| | - Narine A. Sarvazyan
- Department of Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, 2300 Eye Street NW, Washington DC, USA
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Muselimyan N, Swift LM, Asfour H, Chahbazian T, Mazhari R, Mercader MA, Sarvazyan NA. Seeing the Invisible: Revealing Atrial Ablation Lesions Using Hyperspectral Imaging Approach. PLoS One 2016; 11:e0167760. [PMID: 27930718 PMCID: PMC5145191 DOI: 10.1371/journal.pone.0167760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/18/2016] [Indexed: 01/11/2023] Open
Abstract
Background Currently, there are limited means for high-resolution monitoring of tissue injury during radiofrequency ablation procedures. Objective To develop the next generation of visualization catheters that can reveal irreversible atrial muscle damage caused by ablation and identify viability gaps between the lesions. Methods Radiofrequency lesions were placed on the endocardial surfaces of excised human and bovine atria and left ventricles of blood perfused rat hearts. Tissue was illuminated with 365nm light and a series of images were acquired from individual spectral bands within 420-720nm range. By extracting spectral profiles of individual pixels and spectral unmixing, the relative contribution of ablated and unablated spectra to each pixel was then displayed. Results of spectral unmixing were compared to lesion pathology. Results RF ablation caused significant changes in the tissue autofluorescence profile. The magnitude of these spectral changes in human left atrium was relatively small (< 10% of peak fluorescence value), yet highly significant. Spectral unmixing of hyperspectral datasets enabled high spatial resolution, in-situ delineation of radiofrequency lesion boundaries without the need for exogenous markers. Lesion dimensions derived from hyperspectral imaging approach strongly correlated with histological outcomes. Presence of blood within the myocardium decreased the amplitude of the autofluorescence spectra while having minimal effect on their overall shapes. As a result, the ability of hyperspectral imaging to delineate ablation lesions in vivo was not affected. Conclusions Hyperspectral imaging greatly increases the contrast between ablated and unablated tissue enabling visualization of viability gaps at clinically relevant locations. Data supports the possibility for developing percutaneous hyperspectral catheters for high-resolution ablation guidance.
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Affiliation(s)
- Narine Muselimyan
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States of America
| | - Luther M. Swift
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States of America
| | - Huda Asfour
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States of America
| | | | - Ramesh Mazhari
- Division of Cardiology, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, United States of America
| | - Marco A. Mercader
- Division of Cardiology, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, United States of America
| | - Narine A. Sarvazyan
- Department of Pharmacology and Physiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States of America
- * E-mail:
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