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Yang H, Majumder JA, Huang Z, Saluja D, Laurita K, Rollins AM, Hendon CP. Robust, high-density lesion mapping in the left atrium with near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:028001. [PMID: 38419756 PMCID: PMC10901242 DOI: 10.1117/1.jbo.29.2.028001] [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: 11/10/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
Significance Radiofrequency ablation (RFA) procedures for atrial fibrillation frequently fail to prevent recurrence, partially due to limitations in assessing extent of ablation. Optical spectroscopy shows promise in assessing RFA lesion formation but has not been validated in conditions resembling those in vivo. Aim Catheter-based near-infrared spectroscopy (NIRS) was applied to porcine hearts to demonstrate that spectrally derived optical indices remain accurate in blood and at oblique incidence angles. Approach Porcine left atria were ablated and mapped using a custom-fabricated NIRS catheter. Each atrium was mapped first in phosphate-buffered saline (PBS) then in porcine blood. Results NIRS measurements showed little angle dependence up to 60 deg. A trained random forest model predicted lesions with a sensitivity of 81.7%, a specificity of 86.1%, and a receiver operating characteristic curve area of 0.921. Predicted lesion maps achieved a mean structural similarity index of 0.749 and a mean normalized inner product of 0.867 when comparing maps obtained in PBS and blood. Conclusions Catheter-based NIRS can precisely detect RFA lesions on left atria submerged in blood. Optical parameters are reliable in blood and without perpendicular contact, confirming their ability to provide useful feedback during in vivo RFA procedures.
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Affiliation(s)
- Haiqiu Yang
- Columbia University, Department of Electrical Engineering, New York, United States
| | - Jonah A. Majumder
- Columbia University, Department of Biomedical Engineering, New York, United States
| | - Ziyi Huang
- Columbia University, Department of Electrical Engineering, New York, United States
| | - Deepak Saluja
- Columbia University Irving Medical Center, Cardiology Division, Department of Medicine, New York, United States
| | - Kenneth Laurita
- MetroHealth Hospital, Cardiology Division, Department of Medicine, Cleveland, Ohio, United States
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Andrew M. Rollins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio, United States
| | - Christine P. Hendon
- Columbia University, Department of Electrical Engineering, New York, United States
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Harper DJ, Kim Y, Gómez-Ramírez A, Vakoc BJ. Needle guidance with Doppler-tracked polarization-sensitive optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:102910. [PMID: 37799938 PMCID: PMC10548115 DOI: 10.1117/1.jbo.28.10.102910] [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: 05/22/2023] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
Significance Optical coherence tomography (OCT) can be integrated into needle probes to provide real-time navigational guidance. However, unscanned implementations, which are the simplest to build, often struggle to discriminate the relevant tissues. Aim We explore the use of polarization-sensitive (PS) methods as a means to enhance signal interpretability within unscanned coherence tomography probes. Approach Broadband light from a laser centered at 1310 nm was sent through a fiber that was embedded into a needle. The polarization signal from OCT fringes was combined with Doppler-based tracking to create visualizations of the birefringence properties of the tissue. Experiments were performed in (i) well-understood structured tissues (salmon and shrimp) and (ii) ex vivo porcine spine. The porcine experiments were selected to illustrate an epidural guidance use case. Results In the porcine spine, unscanned and Doppler-tracked PS OCT imaging data successfully identified the skin, subcutaneous tissue, ligament, and epidural spaces during needle insertion. Conclusions PS imaging within a needle probe improves signal interpretability relative to structural OCT methods and may advance the clinical utility of unscanned OCT needle probes in a variety of applications.
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Affiliation(s)
- Danielle J. Harper
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Yongjoo Kim
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Alejandra Gómez-Ramírez
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Universidad Nacional de Colombia sede Medellín, School of Physics, Medellín, Colombia
| | - Benjamin J. Vakoc
- Massachusetts General Hospital, Wellman Center for Photomedicine, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, United States
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3
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Huang Z, Zhao X, Ziv O, Laurita KR, Rollins AM, Hendon CP. Automated analysis framework for in vivo cardiac ablation therapy monitoring with optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2023; 14:1228-1242. [PMID: 36950243 PMCID: PMC10026573 DOI: 10.1364/boe.480943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Radiofrequency ablation (RFA) is a minimally invasive procedure that is commonly used for the treatment of atrial fibrillation. However, it is associated with a significant risk of arrhythmia recurrence and complications owing to the lack of direct visualization of cardiac substrates and real-time feedback on ablation lesion transmurality. Within this manuscript, we present an automated deep learning framework for in vivo intracardiac optical coherence tomography (OCT) analysis of swine left atria. Our model can accurately identify cardiac substrates, monitor catheter-tissue contact stability, and assess lesion transmurality on both OCT intensity and polarization-sensitive OCT data. To the best of our knowledge, we have developed the first automatic framework for in vivo cardiac OCT analysis, which holds promise for real-time monitoring and guidance of cardiac RFA therapy..
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Affiliation(s)
- Ziyi Huang
- Department of Electrical Engineering, Columbia University, New York, NY, USA
| | - 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 Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Kenneth R. Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, USA
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4
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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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5
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Park SY, Singh-Moon R, Yang H, Hendon C. Monitoring of irrigated lesion formation with single fiber based multispectral system using machine learning. JOURNAL OF BIOPHOTONICS 2022; 15:e202100374. [PMID: 35666015 PMCID: PMC9452461 DOI: 10.1002/jbio.202100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
In radiofrequency ablation (RFA) treatment of cardiac arrhythmias, intraprocedural assessment of treatment efficacy relies on indirect measures of adequate tissue destruction. Direct sensing of diffuse reflectance spectral changes at the ablation site using optically integrated RFA catheters has been shown to enable accurate prediction of lesion dimensions, ex vivo. Challenges of optical guidance can be due to obtaining reliable measurements under various catheter-tissue contact orientations. In this work, addressed this limitation by assessing the feasibility of monitoring lesion progression using single-fiber reflectance spectroscopy (SFRS). A total of 110 endocardial lesions of various sizes were generated in freshly excised swine right ventricular tissue using a custom-built, irrigated SFRS-RFA catheter. Models were developed for assessing catheter-tissue contact, the presence of nontransmural or transmural lesions and lesion depth percentage. These results support the use of SFRS-based catheters for irrigated lesion assessment and motivate further exploration of using multi-SFRS catheters for omnidirectionality.
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Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Rajinder Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Haiqiu Yang
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027
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6
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Park SY, Yang H, Marboe C, Ziv O, Laurita K, Rollins A, Saluja D, Hendon CP. Cardiac endocardial left atrial substrate and lesion depth mapping using near-infrared spectroscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:1801-1819. [PMID: 35519253 PMCID: PMC9045901 DOI: 10.1364/boe.451547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Atrial fibrillation (AF) is a rapid irregular electrical activity in the upper chamber and the most common sustained cardiac arrhythmia. Many patients require radiofrequency ablation (RFA) therapy to restore sinus rhythm. Pulmonary vein isolation requires distinguishing normal atrial wall from the pulmonary vein tissue, and atrial substrate ablation requires differentiating scar tissue, fibrosis, and adipose tissue. However, current anatomical mapping methods for strategically locating ablation sites by identifying structural substrates in real-time are limited. An intraoperative tool that accurately provides detailed structural information and classifies endocardial substrates could help improve RF guidance during RF ablation therapy. In this work, we propose a 7F NIRS integrated ablation catheter and demonstrate endocardial mapping on ex vivo swine (n = 12) and human (n = 5) left atrium (LA). First, pulmonary vein (PV) sleeve, fibrosis and ablation lesions were identified with NIRS-derived contrast indices. Based on these key spectral features, classification algorithms identified endocardial substrates with high accuracy (<11% error). Then, a predictive model for lesion depth was evaluated on classified lesions. Model predictions correlated well with histological measurements of lesion dimensions (R = 0.984). Classified endocardial substrates and lesion depth were represented in 2D spatial maps. These results suggest NIRS integrated mapping catheters can serve as a complementary tool to the current electroanatomical mapping system to improve treatment efficacy.
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Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, New York, USA
| | - Haiqiu Yang
- Department of Electrical Engineering, Columbia University, New York, USA
| | - Charles Marboe
- Department of Cell Biology and Pathology, Columbia University Irving Medical Center, New York, USA
| | - Ohad Ziv
- Department of Medicine, Cardiology Division, MetroHealth Hospital, Ohio, USA
| | - Kenneth Laurita
- Department of Medicine, Cardiology Division, MetroHealth Hospital, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Ohio, USA
| | - Andrew Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Ohio, USA
| | - Deepak Saluja
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, USA
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7
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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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8
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Anjewierden S, Wazni OM, Vince DG, Kanj M, Saliba W, Fedewa RJ. Cyclic Variation of Spectral Parameters for the Differentiation of Atrial Myocardium Before and Immediately Following Radiofrequency Ablation. ULTRASONIC IMAGING 2021; 43:299-307. [PMID: 34510970 DOI: 10.1177/01617346211046314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Radiofrequency ablation (RFA) is a common treatment of atrial fibrillation. However, current treatment is associated with a greater than 20% recurrence rate, in part due to inadequate monitoring of tissue viability during ablation. Spectral parameters, in particular cyclic variation of integrated backscatter (CVIB), have shown promise as early indicators of myocardial recovery from ischemia. Our aim was to demonstrate the use of spectral parameters to differentiate atrial myocardium before and after radiofrequency ablation. An AcuNav 10 F catheter was used to collect radiofrequency signals from the posterior wall of the left atrium of patients before and immediately after RFA for AF. The normalized power spectrum was obtained and three spectral parameters (integrated backscatter [IB], slope, and intercept) were extracted across two continuous heart cycles. Parameters were gated for ventricular end-diastole and compared before and after ablation. Additionally, the cyclic variation of each of these three parameters was generated as an average of the variation across the two recorded heart cycles. Data from 14 patients before and after ablation demonstrated a significant difference in the magnitude of the cyclic variation of integrated backscatter (9.0 vs. 6.0 dB, p < .001) and cyclic variation of the intercept (14.0 vs. 11.5 dB, p = .04). No significant difference was noted in the magnitude of the cyclic variation of the slope. Among spectral parameters gated for end-diastole, significant differences were noted in the slope (-4.39 vs. -3.73 dB/MHz, p = .002) and intercept (16.8 vs. 11.9 dB, p = .002). No significant difference was noted in the integrated backscatter. Spectral parameters are able to differentiate atrial myocardium before and immediately following ablation and may be useful in monitoring atrial ablations.
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Affiliation(s)
- Scott Anjewierden
- Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - D Geoffrey Vince
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Russell J Fedewa
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
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9
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Park SY, Singh-Moon R, Yang H, Saluja D, Hendon C. Quantification of irrigated lesion morphology using near-infrared spectroscopy. Sci Rep 2021; 11:20160. [PMID: 34635764 PMCID: PMC8505541 DOI: 10.1038/s41598-021-99725-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/29/2021] [Indexed: 12/20/2022] Open
Abstract
There are currently limited means by which lesion formation can be confirmed during radiofrequency ablation procedures. The purpose of this study was to evaluate the use of NIRS-integrated RFA catheters for monitoring irrigated lesion progression, ex vivo and in vivo. Open-irrigated NIRS-ablation catheters with optical fibers were fabricated to sample tissue diffuse reflectance. Spectra from 44 irrigated lesions and 44 non-lesion sites from ex vivo swine hearts (n = 15) were used to train and evaluate a predictive model for lesion dimensions based on key spectral features. Additional studies were performed in diluted blood to assess NIRS signatures of catheter-tissue contact status. Finally, the potential of NIRS-RFA catheters for guiding lesion delivery was evaluated in a set of in vivo pilot studies conducted in healthy pigs (n = 4). Model predictions for lesion depth (R = 0.968), width (R = 0.971), and depth percentage (R = 0.924) correlated well with measured lesion dimensions. In vivo deployment in preliminary trials showed robust translational consistency of contact discrimination (P < 0.0001) and lesion depth parameters (< 3% error). NIRS empowered catheters are well suited for monitoring myocardial response to RF ablation and may provide useful intraprocedural feedback for optimizing treatment efficacy alongside current practices.
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Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Rajinder Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Haiqiu Yang
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA
| | - Deepak Saluja
- Department of Medicine (Cardiology), Columbia University College of Physicians and Surgeons, 630 W. 168th St, New York, NY, 10032, USA
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, 500 West 120th Street, New York, NY, 10027, USA.
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10
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McLean JP, Hendon CP. 3-D compressed sensing optical coherence tomography using predictive coding. BIOMEDICAL OPTICS EXPRESS 2021; 12:2531-2549. [PMID: 33996246 PMCID: PMC8086477 DOI: 10.1364/boe.421848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 05/05/2023]
Abstract
We present a compressed sensing (CS) algorithm and sampling strategy for reconstructing 3-D Optical Coherence Tomography (OCT) image volumes from as little as 10% of the original data. Reconstruction using the proposed method, Denoising Predictive Coding (DN-PC), is demonstrated for five clinically relevant tissue types including human heart, retina, uterus, breast, and bovine ligament. DN-PC reconstructs the difference between adjacent b-scans in a volume and iteratively applies Gaussian filtering to improve image sparsity. An a-line sampling strategy was developed that can be easily implemented in existing Spectral-Domain OCT systems and reduce scan time by up to 90%.
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11
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Tiporlini V, Ahderom S, Pratten P, Alameh K. Advanced fully integrated radiofrequency/optical-coherence-tomography irrigated catheter for atrial fibrillation ablation. JOURNAL OF BIOPHOTONICS 2021; 14:e202000243. [PMID: 33150714 DOI: 10.1002/jbio.202000243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
The inability of current catheter ablation procedures to accurately monitor lesion formation limits their safety and efficacy. An advanced fully integrated radiofrequency (RF)/optical coherence tomography (OCT) ablation catheter is developed, which enables real-time monitoring during ablation. An OCT fiber array is especially designed, developed and integrated into an off-the-shelf irrigated RF ablation catheter. In-vitro experimental studies performed on poultry and ovine hearts demonstrate the ability of the integrated RF/OCT system to provide information on the quality and orientation of catheter/wall contact. Experimental results show that adipose tissue can be accurately identified from normal myocardial tissue with 94% accuracy and lesion formation is monitored with an overall accuracy of 93%. The ability to predict pop events is also demonstrated, with an accuracy of 86%.
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Affiliation(s)
- Valentina Tiporlini
- Electron Science Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Selam Ahderom
- Electron Science Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter Pratten
- Electron Science Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Lazcath PTY LTD, Mosman Park, Western Australia, Australia
| | - Kamal Alameh
- Electron Science Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
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12
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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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13
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Huang Z, Gan Y, Lye T, Zhang H, Laine A, Angelini ED, Hendon C. Heterogeneity Measurement of Cardiac Tissues Leveraging Uncertainty Information from Image Segmentation. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2020; 12261:782-791. [PMID: 34169298 PMCID: PMC8220598 DOI: 10.1007/978-3-030-59710-8_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Identifying arrhythmia substrates and quantifying their heterogeneity has great potential to provide critical guidance for radio frequency ablation. However, quantitative analysis of heterogeneity on cardiac optical coherence tomography (OCT) images is lacking. In this paper, we conduct the first study on quantifying cardiac tissue heterogeneity from human OCT images. Our proposed method applies a dropout-based Monte Carlo sampling technique to measure the model uncertainty. The heterogeneity information is extracted by decoupling the intra/inter-tissue heterogeneity and tissue boundary uncertainty from the uncertainty measurement. We empirically demonstrate that our model can highlight the subtle features from OCT images, and the heterogeneity information extracted is positively correlated with the tissue heterogeneity information from corresponding histology images.
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Affiliation(s)
- Ziyi Huang
- Department of Electrical Engineering, Columbia University, New York, NY, USA
| | - Yu Gan
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL, USA
| | - Theresa Lye
- Department of Electrical Engineering, Columbia University, New York, NY, USA
| | - Haofeng Zhang
- Department of Industrial Engineering and Operations Research, Columbia University, New York, NY, USA
| | - Andrew Laine
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Elsa D Angelini
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
- NIHR Imperial Biomedical Research Centre, ITMAT Data Science Group, Imperial College London, London, UK
| | - Christine Hendon
- Department of Electrical Engineering, Columbia University, New York, NY, USA
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Zhao X, Kilinc O, Blumenthal CJ, Dosluoglu D, Jenkins MW, Snyder CS, Arruda M, Rollins AM. Intracardiac radiofrequency ablation in living swine guided by polarization-sensitive optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-10. [PMID: 32385975 PMCID: PMC7210786 DOI: 10.1117/1.jbo.25.5.056001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
SIGNIFICANCE Pulmonary vein isolation with catheter-based radiofrequency ablation (RFA) is carried out frequently to treat atrial fibrillation. However, RFA lesion creation is only guided by indirect information (e.g., temperature, impedance, and contact force), which may result in poor lesion quality (e.g., nontransmural) and can lead to reoccurrence or complications. AIM The feasibility of guiding intracardiac RFA with an integrated polarization-sensitive optical coherence tomography (PSOCT)-RFA catheter in the right atria (RA) of living swine is demonstrated. APPROACH In total, 12 sparse lesions were created in the RA of three living swine using an integrated PSOCT-RFA catheter with standard ablation protocol. PSOCT images were displayed in real time to guide catheter-tissue apposition. After experiments, post-processed PSOCT images were analyzed to assess lesion quality and were compared with triphenyltetrazolium chloride (TTC) lesion quality analysis. RESULTS Five successful lesions identified with PSOCT images were all confirmed by TTC analysis. In two ablations, PSOCT imaging detected gas bubble formation, indicating overtreatment. Unsuccessful lesions observed with PSOCT imaging were confirmed by TTC analysis. CONCLUSIONS The results demonstrate that the PSOCT-RFA catheter provides real-time feedback to guide catheter-tissue apposition, monitor lesion quality, and possibly help avoid complications due to overtreatment, which may enable more effective and safer RFA treatment.
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Affiliation(s)
- Xiaowei Zhao
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, United States
| | - Orhan Kilinc
- Rainbow Babies and Children’s Hospital, The Congenital Heart Collaborative, Cleveland, United States
| | - Colin J. Blumenthal
- Case Western Reserve University, School of Medicine, Cleveland, United States
| | - Deniz Dosluoglu
- Case Western Reserve University, Department of Electric Engineering and Computer Science, Cleveland, United States
| | - Michael W. Jenkins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, United States
- Case Western Reserve University, Department of Pediatrics, Cleveland, United States
| | - Christopher S. Snyder
- Rainbow Babies and Children’s Hospital, The Congenital Heart Collaborative, Cleveland, United States
- Case Western Reserve University, School of Medicine, Cleveland, United States
- Case Western Reserve University, Department of Pediatrics, Cleveland, United States
| | - Mauricio Arruda
- Case Western Reserve University, School of Medicine, Cleveland, United States
- University Hospitals Cleveland Medical Center, EP Laboratories and the Atrial Fibrillation Center at the Harrington Heart and Vascular Institute, Cleveland, United States
| | - Andrew M. Rollins
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, United States
- Case Western Reserve University, School of Medicine, Cleveland, United States
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15
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Mora OC, Zanne P, Zorn L, Nageotte F, Zulina N, Gravelyn S, Montgomery P, de Mathelin M, Dallemagne B, Gora MJ. Steerable OCT catheter for real-time assistance during teleoperated endoscopic treatment of colorectal cancer. BIOMEDICAL OPTICS EXPRESS 2020; 11:1231-1243. [PMID: 32206405 PMCID: PMC7075597 DOI: 10.1364/boe.381357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 05/06/2023]
Abstract
When detected early, colorectal cancer can be treated with minimally invasive flexible endoscopy. However, since only specialized experts can delineate margins and perform endoscopic resections of lesions, patients still often undergo colon resections. To better assist in the performance of surgical tasks, a robotized flexible interventional endoscope was previously developed, having two additional side channels for surgical instrument. We propose to enhance the imaging capabilities of this device by combining it with optical coherence tomography (OCT). For this purpose, we have developed a new steerable OCT instrument with an outer diameter of 3.5 mm. The steerable instrument is terminated with a 2 cm long transparent sheath to allow three-dimensional OCT imaging using a side-focusing optical probe with two external scanning actuators. The instrument is connected to an OCT imaging system built around the OCT Axsun engine, with a 1310 nm center wavelength swept source laser and 100 kHz A-line rate. Once inserted in one of the side channels of the robotized endoscope, bending, rotation and translation of the steerable OCT instrument can be controlled by a physician using a joystick. Ex vivo and in vivo tests show that the novel, steerable and teleoperated OCT device enhances dexterity, allowing for inspection of the surgical field without the need for changing the position of the main endoscope.
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Affiliation(s)
- Oscar Caravaca Mora
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Philippe Zanne
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Lucile Zorn
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Florent Nageotte
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Natalia Zulina
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Sara Gravelyn
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Paul Montgomery
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Michel de Mathelin
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
| | - Bernard Dallemagne
- IRCAD - Hôpitaux Universitaires - 1, place de l'Hôpital - 67091 Strasbourg Cedex, France
| | - Michalina J Gora
- ICube Laboratory, CNRS, Strasbourg University, 4, rue Kirschleger - 67085 Strasbourg Cedex, France
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16
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Wan J, Ling X, Rao Z, Peng B, Ding G. Independent prognostic value of HIF-1α expression in radiofrequency ablation of lung cancer. Oncol Lett 2020; 19:849-857. [PMID: 31897199 PMCID: PMC6924154 DOI: 10.3892/ol.2019.11130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/20/2019] [Indexed: 01/11/2023] Open
Abstract
Radiofrequency ablation (RFA) is widely used in the treatment of lung cancer. Hypoxia-inducible factor-1α (HIF-1α) is a crucial transcription factor regulating oxygen homeostasis that is involved in tumor cell metastasis. The present study investigated the impact of HIF-1α expression and other factors, such as postoperative blood CD4+/CD8+ ratio, on the prognosis of patients with lung cancer who had received RFA treatment. A total of 80 patients with lung cancer were recruited between January 2011 and October 2016 at The Shenzhen People's Hospital. Lung cancer was confirmed following pathological or histological examination. All patients underwent RFA treatment. Patients were followed up for 6–66 months. HIF-1α expression in lung cancer tissues was assessed by immunohistochemistry. Multivariate survival analysis was performed using Cox proportional hazards model. The results demonstrated that HIF-1α level was low in 36 patients and overexpressed in 44 patients with lung cancer. Kaplan-Meier (KM) curve analysis demonstrated that the overall survival time of patients with high HIF-1α expression was significantly shorter compared with patients with low HIF-1α expression (P<0.05). Furthermore, the results from the KM model and log-rank test revealed that age, Union for International Cancer Control stage, primary or metastatic cancer, chemotherapy, postoperative blood CD4+/CD8+ ratio, Eastern Cooperative Oncology Group performance status and HIF-1α expression had significant effects on overall survival of patients with lung cancer. The results from Cox analysis demonstrated that high HIF-1α expression, advanced age, clinical staging and chemotherapy were independent risk factors for the prognosis of lung cancer following RFA treatment, and that high HIF-1α expression was associated with the increased risk (5.91-fold) of mortality. In conclusion, the present study demonstrated that HIF-1α expression was increased in lung cancer tissues and was associated with the prognosis of patients with lung cancer who were treated with RFA. These findings suggest that HIF-1α expression may be considered as a marker for evaluating the prognosis of these patients.
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Affiliation(s)
- Jun Wan
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Xiean Ling
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Zhanpeng Rao
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Bin Peng
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Guanggui Ding
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
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17
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Gan Y, Lye TH, Marboe CC, Hendon CP. Characterization of the human myocardium by optical coherence tomography. JOURNAL OF BIOPHOTONICS 2019; 12:e201900094. [PMID: 31400074 PMCID: PMC7456394 DOI: 10.1002/jbio.201900094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/25/2019] [Accepted: 08/08/2019] [Indexed: 05/21/2023]
Abstract
Imaging of cardiac tissue structure plays a critical role in the treatment and understanding of cardiovascular disease. Optical coherence tomography (OCT) offers the potential to provide valuable, high-resolution imaging of cardiac tissue. However, there is a lack of comprehensive OCT imaging data of the human heart, which could improve identification of structural substrates underlying cardiac abnormalities. The objective of this study was to provide qualitative and quantitative analysis of OCT image features throughout the human heart. Fifty human hearts were acquired, and tissues from all chambers were imaged with OCT. Histology was obtained to verify tissue composition. Statistical differences between OCT image features corresponding to different tissue types and chambers were estimated using analysis of variance. OCT imaging provided features that were able to distinguish structures such as thickened collagen, as well as adipose tissue and fibrotic myocardium. Statistically significant differences were found between atria and ventricles in attenuation coefficient, and between adipose and all other tissue types. This study provides an overview of OCT image features throughout the human heart, which can be used for guiding future applications such as OCT-integrated catheter-based treatments or ex vivo investigation of structural substrates.
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Affiliation(s)
- Yu Gan
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Theresa H. Lye
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Charles C. Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, New York, New York
- Correspondence: Christine P. Hendon, Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY 10032.
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18
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Iskander-Rizk S, Kruizinga P, Beurskens R, Springeling G, Mastik F, de Groot NM, Knops P, van der Steen AF, van Soest G. Real-time photoacoustic assessment of radiofrequency ablation lesion formation in the left atrium. PHOTOACOUSTICS 2019; 16:100150. [PMID: 31871891 PMCID: PMC6909067 DOI: 10.1016/j.pacs.2019.100150] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/24/2019] [Accepted: 11/13/2019] [Indexed: 05/20/2023]
Abstract
In interventional electrophysiology, catheter-based radiofrequency (RF) ablation procedures restore cardiac heart rhythm by interrupting aberrant conduction paths. Real-time feedback on lesion formation and post-treatment lesion assessment could overcome procedural challenges related to ablation of underlying structures and lesion gaps. This study aims to evaluate real-time visualization of lesion progression and continuity during intra-atrial ablation with photoacoustic (PA) imaging, using clinically deployable technology. A PA-enabled RF ablation catheter was used to ablate and illuminate porcine left atrium, both excised and intact in a passive beating heart ex-vivo, for photoacoustic signal generation. PA signals were received with an intracardiac echography catheter. Using the ratio of PA images acquired with excitation wavelengths of 790 nm and 930 nm, ablation lesions were successfully imaged through circulating saline and/or blood, and lesion gaps were identified in real-time. PA-based assessment of RF-ablation lesions was successful in a realistic preclinical model of atrial intervention.
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Affiliation(s)
- Sophinese Iskander-Rizk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Corresponding author at: Department of Biomedical Engineering, Erasmus Medical Center, Ee-2322, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Pieter Kruizinga
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Robert Beurskens
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Geert Springeling
- Department of Experimental Medical Instruments, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Frits Mastik
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Natasja M.S. de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Antonius F.W. van der Steen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
- Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Gijs van Soest
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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19
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Lye TH, Marboe CC, Hendon CP. Imaging of subendocardial adipose tissue and fiber orientation distributions in the human left atrium using optical coherence tomography. J Cardiovasc Electrophysiol 2019; 30:2950-2959. [PMID: 31661178 PMCID: PMC6916589 DOI: 10.1111/jce.14255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Background Optical coherence tomography (OCT) has the potential to provide real‐time imaging guidance for atrial fibrillation ablation, with promising results for lesion monitoring. OCT can also offer high‐resolution imaging of tissue composition, but there is insufficient cardiac OCT data to inform the use of OCT to reveal important tissue architecture of the human left atrium. Thus, the objective of this study was to define OCT imaging data throughout the human left atrium, focusing on the distribution of adipose tissue and fiber orientation as seen from the endocardium. Methods and Results Human hearts (n = 7) were acquired for imaging the left atrium with OCT. A spectral‐domain OCT system with 1325 nm center wavelength, 6.5 μm axial resolution, 15 μm lateral resolution, and a maximum imaging depth of 2.51 mm in the air was used. Large‐scale OCT image maps of human left atrial tissue were developed, with adipose thickness and fiber orientation extracted from the imaging data. OCT imaging showed scattered distributions of adipose tissue around the septal and pulmonary vein regions, up to a depth of about 0.43 mm from the endocardial surface. The total volume of adipose tissue detected by OCT over one left atrium ranged from 1.42 to 28.74 mm3. Limited fiber orientation information primarily around the pulmonary veins and the septum could be identified. Conclusion OCT imaging could provide adjunctive information on the distribution of subendocardial adipose tissue, particularly around thin areas around the pulmonary veins and septal regions. Variations in OCT‐detected tissue composition could potentially assist ablation guidance.
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Affiliation(s)
- Theresa H Lye
- Department of Electrical Engineering, Columbia University, New York, NY
| | - Charles C Marboe
- Department of Pathology, Columbia University Medical Center, New York, NY
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20
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Yu X, Singh-Moon RP, Hendon CP. Real-time assessment of catheter contact and orientation using an integrated optical coherence tomography cardiac ablation catheter. APPLIED OPTICS 2019; 58:3823-3829. [PMID: 31158201 DOI: 10.1364/ao.58.003823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/10/2019] [Indexed: 05/21/2023]
Abstract
The efficacy of catheter ablation treatment for atrial fibrillation is directly impacted by the quality of lesion formation. Two parameters that are critical for maximizing energy delivery are sustained catheter contact and orientation. Currently, these parameters must be inferred indirectly through tactile feedback or measurements of bioelectrical impedance and tip force. In this work, we propose a method for discerning contact and orientation based on direct endomyocardial imaging mediated by optical coherence tomography (OCT)-integrated ablation catheters. A two-stage classifier is developed to deduce contact parameters from M-mode images. Experimental validation within swine left-atrial specimens demonstrate accuracies of 99.96% and 92.88% for contact and orientation stages, respectively. These results highlight the potential of OCT M-mode imaging for guiding catheter placement during radiofrequency ablation interventions.
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21
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Hendon CP, Lye TH, Yao X, Gan Y, Marboe CC. Optical coherence tomography imaging of cardiac substrates. Quant Imaging Med Surg 2019; 9:882-904. [PMID: 31281782 PMCID: PMC6571187 DOI: 10.21037/qims.2019.05.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/06/2019] [Indexed: 01/02/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Knowledge of a patient's heart structure will help to plan procedures, potentially identifying arrhythmia substrates, critical structures to avoid, detect transplant rejection, and reduce ambiguity when interpreting electrograms and functional measurements. Similarly, basic research of numerous cardiac diseases would greatly benefit from structural imaging at cellular scale. For both applications imaging on the scale of a myocyte is needed, which is approximately 100 µm × 10 µm. The use of optical coherence tomography (OCT) as a tool for characterizing cardiac tissue structure and function has been growing in the past two decades. We briefly review OCT principles and highlight important considerations when imaging cardiac muscle. In particular, image penetration, tissue birefringence, and light absorption by blood during in vivo imaging are important factors when imaging the heart with OCT. Within the article, we highlight applications of cardiac OCT imaging including imaging heart tissue structure in small animal models, quantification of myofiber organization, monitoring of radiofrequency ablation (RFA) lesion formation, structure-function analysis enabled by functional extensions of OCT and multimodal analysis and characterizing important substrates within the human heart. The review concludes with a summary and future outlook of OCT imaging the heart, which is promising with progress in optical catheter development, functional extensions of OCT, and real time image processing to enable dynamic imaging and real time tracking during therapeutic procedures.
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Affiliation(s)
| | | | | | - Yu Gan
- Columbia University, New York, NY, USA
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22
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Lo WCY, Uribe-Patarroyo N, Hoebel K, Beaudette K, Villiger M, Nishioka NS, Vakoc BJ, Bouma BE. Balloon catheter-based radiofrequency ablation monitoring in porcine esophagus using optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2019; 10:2067-2089. [PMID: 31086717 PMCID: PMC6484999 DOI: 10.1364/boe.10.002067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 05/05/2023]
Abstract
We present a microscopic image guidance platform for radiofrequency ablation (RFA) using a clinical balloon-catheter-based optical coherence tomography (OCT) system, currently used in the surveillance of Barrett's esophagus patients. Our integrated thermal therapy delivery and monitoring platform consists of a flexible, customized bipolar RFA electrode array designed for use with a clinical balloon OCT catheter and a processing algorithm to accurately map the thermal coagulation process. Non-uniform rotation distortion was corrected using a feature tracking-based technique, which enables robust, frame-to-frame analysis of the temporal fluctuation of the complex OCT signal. With proper noise calibration, precise delineation of the thermal therapy zone was demonstrated using cumulative complex differential variance in porcine esophagus ex vivo with the integrated OCT-RFA system, as validated by nitroblue tetrazolium chloride (NBTC) histology. The ability to directly and accurately visualize the thermal coagulation process at high resolution is critical to the precise delivery of thermal energy to a wide range of epithelial lesions.
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Affiliation(s)
- William C Y Lo
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
| | - Néstor Uribe-Patarroyo
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
| | - Katharina Hoebel
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
| | - Kathy Beaudette
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
| | - Norman S Nishioka
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114, USA
| | - Benjamin J Vakoc
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
| | - Brett E Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
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