1
|
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.
Collapse
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
| |
Collapse
|
2
|
John S, Hester S, Basij M, Paul A, Xavierselvan M, Mehrmohammadi M, Mallidi S. Niche preclinical and clinical applications of photoacoustic imaging with endogenous contrast. PHOTOACOUSTICS 2023; 32:100533. [PMID: 37636547 PMCID: PMC10448345 DOI: 10.1016/j.pacs.2023.100533] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023]
Abstract
In the past decade, photoacoustic (PA) imaging has attracted a great deal of popularity as an emergent diagnostic technology owing to its successful demonstration in both preclinical and clinical arenas by various academic and industrial research groups. Such steady growth of PA imaging can mainly be attributed to its salient features, including being non-ionizing, cost-effective, easily deployable, and having sufficient axial, lateral, and temporal resolutions for resolving various tissue characteristics and assessing the therapeutic efficacy. In addition, PA imaging can easily be integrated with the ultrasound imaging systems, the combination of which confers the ability to co-register and cross-reference various features in the structural, functional, and molecular imaging regimes. PA imaging relies on either an endogenous source of contrast (e.g., hemoglobin) or those of an exogenous nature such as nano-sized tunable optical absorbers or dyes that may boost imaging contrast beyond that provided by the endogenous sources. In this review, we discuss the applications of PA imaging with endogenous contrast as they pertain to clinically relevant niches, including tissue characterization, cancer diagnostics/therapies (termed as theranostics), cardiovascular applications, and surgical applications. We believe that PA imaging's role as a facile indicator of several disease-relevant states will continue to expand and evolve as it is adopted by an increasing number of research laboratories and clinics worldwide.
Collapse
Affiliation(s)
- Samuel John
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Scott Hester
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Avijit Paul
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | | | - Mohammad Mehrmohammadi
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
- Wilmot Cancer Institute, Rochester, NY, USA
| | - Srivalleesha Mallidi
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| | | |
Collapse
|
6
|
Krist D, Linz D, Schotten U, Zeemering S, Leenen D. A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:834856. [PMID: 35387364 PMCID: PMC8979165 DOI: 10.3389/fmedt.2022.834856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Aim This proof-of-concept study aimed to investigate atrial and ventricular lesion formation by a 20-mm linear laser ablation catheter, regarding lesion depth and tissue damage. Methods In total, 6 female swines underwent standard femoral vein access to introduce a novel 20-mm linear laser ablation catheter in the right atrium to perform endocardial cavotricuspid isthmus (CTI) ablations. The navigation took place under fluoroscopy with additional visualization by intracardiac echocardiograph. Via a sternotomy, epicardial ablations were performed on the surface of the left ventricle (LV), right ventricle (RV), and right atrial appendage (RAA). Procedural safety was assessed by registration of intraprocedural adverse events and by macroscopic examination of the excised hearts for the presence of charring or tissue disruption at the lesion site. Results Altogether 39 lesions were created, including 8 endocardial CTI (mean lesion length 20.6 ± 1.65 mm), 26 epicardial ventricle (mean lesion length LV: 25.3 ± 1.35 mm, RV: 24.9 ± 2.40 mm), and 5 epicardial appendage ablations (mean lesion length RAA: 26.0 ± 3.16 mm). Transmurality was achieved in all CTI and atrial appendage ablations, in 62% of the RV ablations and in none of the LV ablations. No perforation or steam pop occurred, and no animal died during the procedure. Conclusion In this porcine study, the 20-mm linear laser ablation catheter has shown excellent results for endocardial cavotricuspid isthmus ablation, and it resulted in acceptable lesion depth during atrial and ventricular epicardial ablation. The absence of tissue charring, steam pops, or microbubbles under the experimental conditions suggests a high degree of procedural safety.
Collapse
Affiliation(s)
- Dennis Krist
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- *Correspondence: Dennis Krist
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiology, Maastricht University Medical Centre +, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Dwayne Leenen
- Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Towards Intraoperative Quantification of Atrial Fibrosis Using Light-Scattering Spectroscopy and Convolutional Neural Networks. SENSORS 2021; 21:s21186033. [PMID: 34577240 PMCID: PMC8471003 DOI: 10.3390/s21186033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 01/06/2023]
Abstract
Light-scattering spectroscopy (LSS) is an established optical approach for characterization of biological tissues. Here, we investigated the capabilities of LSS and convolutional neural networks (CNNs) to quantitatively characterize the composition and arrangement of cardiac tissues. We assembled tissue constructs from fixed myocardium and the aortic wall with a thickness similar to that of the atrial free wall. The aortic sections represented fibrotic tissue. Depth, volume fraction, and arrangement of these fibrotic insets were varied. We gathered spectra with wavelengths from 500–1100 nm from the constructs at multiple locations relative to a light source. We used single and combinations of two spectra for training of CNNs. With independently measured spectra, we assessed the accuracy of the CNNs for the classification of tissue constructs from single spectra and combined spectra. Combined spectra, including the spectra from fibers distal from the illumination fiber, typically yielded the highest accuracy. The maximal classification accuracy of the depth detection, volume fraction, and permutated arrangements was (mean ± standard deviation (stddev)) 88.97 ± 2.49%, 76.33 ± 1.51%, and 84.25 ± 1.88%, respectively. Our studies demonstrate the reliability of quantitative characterization of tissue composition and arrangements using a combination of LSS and CNNs. The potential clinical applications of the developed approach include intraoperative quantification and mapping of atrial fibrosis, as well as the assessment of ablation lesions.
Collapse
|
10
|
Zaltieri M, Massaroni C, Cauti FM, Schena E. Techniques for Temperature Monitoring of Myocardial Tissue Undergoing Radiofrequency Ablation Treatments: An Overview. SENSORS (BASEL, SWITZERLAND) 2021; 21:1453. [PMID: 33669692 PMCID: PMC7922285 DOI: 10.3390/s21041453] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Cardiac radiofrequency ablation (RFA) has received substantial attention for the treatment of multiple arrhythmias. In this scenario, there is an ever-growing demand for monitoring the temperature trend inside the tissue as it may allow an accurate control of the treatment effects, with a consequent improvement of the clinical outcomes. There are many methods for monitoring temperature in tissues undergoing RFA, which can be divided into invasive and non-invasive. This paper aims to provide an overview of the currently available techniques for temperature detection in this clinical scenario. Firstly, we describe the heat generation during RFA, then we report the principle of work of the most popular thermometric techniques and their features. Finally, we introduce their main applications in the field of cardiac RFA to explore the applicability in clinical settings of each method.
Collapse
Affiliation(s)
- Martina Zaltieri
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Carlo Massaroni
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Cardiology Division, S. Giovanni Calibita Hospital, Isola Tiberina, 00186 Rome, Italy;
| | - Emiliano Schena
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (M.Z.); (C.M.)
| |
Collapse
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
Singh-Moon RP, Park SY, Song Cho DM, Vaidya A, Marboe CC, Wan EY, Hendon CP. Feasibility of near-infrared spectroscopy as a tool for anatomical mapping of the human epicardium. BIOMEDICAL OPTICS EXPRESS 2020; 11:4099-4109. [PMID: 32923031 PMCID: PMC7449747 DOI: 10.1364/boe.394294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/24/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Epicardial ablation is necessary for the treatment of ventricular tachycardias refractory to endocardial ablation due to arrhythmic substrates involving the epicardium. The human epicardium is composed of adipose tissue and coronary vasculature embedded on the surface and within the myocardium, which can complicate electroanatomical mapping, electrogram interpretation and ablation delivery. We propose using near-infrared spectroscopy (NIRS) to decipher adipose tissue from myocardial tissue within human hearts ex vivo. Histological measurement of epicardial adipose thickness direct correlated (R = 0.884) with the adipose contrast index. These results demonstrate the potential of NIRS integrated catheters for mapping the spatial distribution of epicardial substrates and could aid in improving guidance during epicardial ablation interventions.
Collapse
Affiliation(s)
| | - Soo Young Park
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Diego M Song Cho
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Agastya Vaidya
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Charles C Marboe
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Elaine Y Wan
- Department of Medicine, Cardiology Division, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Christine P Hendon
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| |
Collapse
|
13
|
Lee P, Quintanilla JG, Alfonso-Almazán JM, Galán-Arriola C, Yan P, Sánchez-González J, Pérez-Castellano N, Pérez-Villacastín J, Ibañez B, Loew LM, Filgueiras-Rama D. In vivo ratiometric optical mapping enables high-resolution cardiac electrophysiology in pig models. Cardiovasc Res 2020; 115:1659-1671. [PMID: 30753358 PMCID: PMC6704389 DOI: 10.1093/cvr/cvz039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 11/28/2022] Open
Abstract
Aims Cardiac optical mapping is the gold standard for measuring complex electrophysiology in ex vivo heart preparations. However, new methods for optical mapping in vivo have been elusive. We aimed at developing and validating an experimental method for performing in vivo cardiac optical mapping in pig models. Methods and results First, we characterized ex vivo the excitation-ratiometric properties during pacing and ventricular fibrillation (VF) of two near-infrared voltage-sensitive dyes (di-4-ANBDQBS/di-4-ANEQ(F)PTEA) optimized for imaging blood-perfused tissue (n = 7). Then, optical-fibre recordings in Langendorff-perfused hearts demonstrated that ratiometry permits the recording of optical action potentials (APs) with minimal motion artefacts during contraction (n = 7). Ratiometric optical mapping ex vivo also showed that optical AP duration (APD) and conduction velocity (CV) measurements can be accurately obtained to test drug effects. Secondly, we developed a percutaneous dye-loading protocol in vivo to perform high-resolution ratiometric optical mapping of VF dynamics (motion minimal) using a high-speed camera system positioned above the epicardial surface of the exposed heart (n = 11). During pacing (motion substantial) we recorded ratiometric optical signals and activation via a 2D fibre array in contact with the epicardial surface (n = 7). Optical APs in vivo under general anaesthesia showed significantly faster CV [120 (63–138) cm/s vs. 51 (41–64) cm/s; P = 0.032] and a statistical trend to longer APD90 [242 (217–254) ms vs. 192 (182–233) ms; P = 0.095] compared with ex vivo measurements in the contracting heart. The average rate of signal-to-noise ratio (SNR) decay of di-4-ANEQ(F)PTEA in vivo was 0.0671 ± 0.0090 min−1. However, reloading with di-4-ANEQ(F)PTEA fully recovered the initial SNR. Finally, toxicity studies (n = 12) showed that coronary dye injection did not generate systemic nor cardiac damage, although di-4-ANBDQBS injection induced transient hypotension, which was not observed with di-4-ANEQ(F)PTEA. Conclusions In vivo optical mapping using voltage ratiometry of near-infrared dyes enables high-resolution cardiac electrophysiology in translational pig models.
Collapse
Affiliation(s)
- Peter Lee
- Essel Research and Development Inc., Toronto, 337 Sheppard Ave East, Toronto, Ontario M2N 3B3, Canada
| | - Jorge G Quintanilla
- Spanish National Cardiovascular Research Center, Carlos III (CNIC), Myocardial Pathophysiology Area, Melchor Fernández Almagro, 3, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos 3-5, Madrid, Spain.,Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof. Martín Lagos s/n, Madrid, Spain
| | - José M Alfonso-Almazán
- Spanish National Cardiovascular Research Center, Carlos III (CNIC), Myocardial Pathophysiology Area, Melchor Fernández Almagro, 3, Madrid, Spain
| | - Carlos Galán-Arriola
- Spanish National Cardiovascular Research Center, Carlos III (CNIC), Myocardial Pathophysiology Area, Melchor Fernández Almagro, 3, Madrid, Spain
| | - Ping Yan
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | | | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos 3-5, Madrid, Spain.,Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof. Martín Lagos s/n, Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos 3-5, Madrid, Spain.,Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof. Martín Lagos s/n, Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Paseo de San Francisco de Sales 3, Madrid, Spain
| | - Borja Ibañez
- Spanish National Cardiovascular Research Center, Carlos III (CNIC), Myocardial Pathophysiology Area, Melchor Fernández Almagro, 3, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos 3-5, Madrid, Spain.,IIS-University Hospital Fundación Jiménez Díaz, Department of Cardiology, Av. Reyes Católicos 2, Madrid, Spain
| | - Leslie M Loew
- Richard D. Berlin Center for Cell Analysis and Modeling, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - David Filgueiras-Rama
- Spanish National Cardiovascular Research Center, Carlos III (CNIC), Myocardial Pathophysiology Area, Melchor Fernández Almagro, 3, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Av. Monforte de Lemos 3-5, Madrid, Spain.,Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Prof. Martín Lagos s/n, Madrid, Spain
| |
Collapse
|
14
|
Abstract
High-density (HD) mapping presents opportunities to enhance delineation of atrial fibrillation (AF) substrate, improve efficiency of the mapping procedure without sacrificing safety, and afford new mechanistic insights regarding AF. Innovations in hardware, software algorithms, and development of novel multielectrode catheters have allowed HD mapping to be feasible and reliable. Patients to particularly benefit from this technology are those with paroxysmal AF in setting of preexisting atrial scar, persistent AF, and AF in the setting of complex congenital heart disease. The future will bring refinements in automated HD mapping including evolution of noncontact methodologies and artificial intelligence to supplant current techniques.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Iskander-Rizk S, van der Steen AFW, van Soest G. Photoacoustic imaging for guidance of interventions in cardiovascular medicine. Phys Med Biol 2019; 64:16TR01. [PMID: 31048573 DOI: 10.1088/1361-6560/ab1ede] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Imaging guidance is paramount to procedural success in minimally invasive interventions. Catheter-based therapies are the standard of care in the treatment of many cardiac disorders, including coronary artery disease, structural heart disease and electrophysiological conditions. Many of these diseases are caused by, or effect, a change in vasculature or cardiac tissue composition, which can potentially be detected by photoacoustic imaging. This review summarizes the state of the art in photoacoustic imaging approaches that have been proposed for intervention guidance in cardiovascular care. All of these techniques are currently in the preclinical phase. We will conclude with an outlook towards clinical applications.
Collapse
Affiliation(s)
- Sophinese Iskander-Rizk
- Department of Cardiology, Biomedical Engineering, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | | | | |
Collapse
|
17
|
Park SY, Singh-Moon RP, Wan EY, Hendon CP. Towards real-time multispectral endoscopic imaging for cardiac lesion quality assessment. BIOMEDICAL OPTICS EXPRESS 2019; 10:2829-2846. [PMID: 31259054 PMCID: PMC6583339 DOI: 10.1364/boe.10.002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 05/08/2023]
Abstract
Atrial fibrillation (Afib) can lead to life threatening conditions such as heart failure and stroke. During Afib treatment, clinicians aim to repress unusual electrical activity by electrically isolating the pulmonary veins (PV) from the left atrium (LA) using radiofrequency ablation. However, current clinical tools are limited in reliably assessing transmurality of the ablation lesions and detecting the presence of gaps within ablation lines, which can warrant repeat procedures. In this study, we developed an endoscopic multispectral reflectance imaging (eMSI) system for enhanced discrimination of tissue treatment at the PV junction. The system enables direct visualization of cardiac lesions through an endoscope at acquisition rates up to 25 Hz. Five narrowband, high-power LEDs were used to illuminate the sample (450, 530, 625, 810 and 940nm) and combinatory parameters were calculated based on their relative reflectance. A stitching algorithm was employed to generate large field-of-view, multispectral mosaics of the ablated PV junction from individual eMSI images. A total of 79 lesions from 15 swine hearts were imaged, ex vivo. Statistical analysis of the acquired five spectral data sets and ratiometric maps revealed significant differences between transmural lesions, non-transmural lesions around the venoatrial junctions, unablated posterior wall of left atrium tissue, and pulmonary vein (p < 0.0001). A pixel-based quadratic discriminant analysis classifier was applied to distinguish four tissue types: PV, untreated LA, non-transmural and transmural lesions. We demonstrate tissue type classification accuracies of 80.2% and 92.1% for non-transmural and transmural lesions, and 95.0% and 92.8% for PV and untreated LA sites, respectively. These findings showcase the potential of eMSI for lesion validation and may help to improve AFib treatment efficacy.
Collapse
Affiliation(s)
- Soo Young Park
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| | - Rajinder P. Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| | - Elaine Y. Wan
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY, 10027, USA
| |
Collapse
|
18
|
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 DOI: 10.21037/qims.2019.05.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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.
Collapse
Affiliation(s)
| | | | | | - Yu Gan
- Columbia University, New York, NY, USA
| | | |
Collapse
|
19
|
Tissue-Specific Optical Mapping Models of Swine Atria Informed by Optical Coherence Tomography. Biophys J 2019; 114:1477-1489. [PMID: 29590604 PMCID: PMC5883619 DOI: 10.1016/j.bpj.2018.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022] Open
Abstract
Computational models and experimental optical mapping of cardiac electrophysiology serve as powerful tools to investigate the underlying mechanisms of arrhythmias. Modeling can also aid the interpretation of optical mapping signals, which may have different characteristics with respect to the underlying electrophysiological signals they represent. However, despite the prevalence of atrial arrhythmias such as atrial fibrillation, models of optical electrical mapping incorporating realistic structure of the atria are lacking. Therefore, we developed image-based models of atrial tissue using structural information extracted from optical coherence tomography (OCT), which can provide volumetric tissue characteristics in high resolution. OCT volumetric data of four swine atrial tissue samples were used to develop models incorporating tissue geometry, tissue-specific myofiber orientation, and ablation lesion regions. We demonstrated the use of these models through electrophysiology and photon scattering simulations. Changes in transmural electrical conduction were observed with the inclusion of OCT-derived, depth-resolved fiber orientation. Additionally, the amplitude of optical mapping signals were not found to correspond with lesion transmurality because of lesion geometry and electrical propagation occurring beyond excitation light penetration. This work established a framework for the development of tissue-specific models of atrial tissue derived from OCT imaging data, which can be useful in future investigations of electrophysiology and optical mapping signals with respect to realistic atrial tissue structure.
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Zhao X, Fu X, Blumenthal C, Wang YT, Jenkins MW, Snyder C, Arruda M, Rollins AM. Integrated RFA/PSOCT catheter for real-time guidance of cardiac radio-frequency ablation. BIOMEDICAL OPTICS EXPRESS 2018; 9:6400-6411. [PMID: 31065438 PMCID: PMC6490984 DOI: 10.1364/boe.9.006400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 05/21/2023]
Abstract
Radiofrequency ablation (RFA) is an important standard therapy for cardiac arrhythmias, but direct monitoring of tissue treatment is currently lacking. We demonstrate an RFA catheter integrated with polarization sensitive optical coherence tomography (PSOCT) for directly monitoring the RFA process in real time. The integrated RFA/OCT catheter was modified from a standard clinical RFA catheter and includes a miniature forward-viewing cone-scanning OCT probe. The PSOCT system was validated with a quarter-wave plate while the RFA function of the integrated catheter was validated by comparing lesion sizes with those made with an unmodified RFA catheter. Additionally, the integrated catheter guided catheter-tissue apposition and monitored RFA lesion formation in cardiac tissue in real time. The results show that catheter-tissue contact can be characterized by observing the features of the blood and tissue in the acquired OCT images and that RFA lesion formation can be confirmed by monitoring the change in phase retardance in the acquired PSOCT images. This system demonstrates the feasibility of an integrated RFA/OCT catheter to deliver RF energy and image the cardiac wall simultaneously and justifies further research into use of this technology to aid RFA therapy for cardiac arrhythmias.
Collapse
Affiliation(s)
- Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- authors contributed equally
| | - Xiaoyong Fu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- authors contributed equally
| | - Colin Blumenthal
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Yves T. Wang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Christopher Snyder
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
- Rainbow Babies and Children’s Hospital, Division of Pediatric Cardiology, University Hospitals, Cleveland, OH 44106, USA
| | - Mauricio Arruda
- Department of Cardiology, University Hospitals Case Medical Center, Cleveland, OH 44120, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| |
Collapse
|
22
|
Yao X, Gan Y, Ling Y, Marboe CC, Hendon CP. Multicontrast endomyocardial imaging by single-channel high-resolution cross-polarization optical coherence tomography. JOURNAL OF BIOPHOTONICS 2018; 11:e201700204. [PMID: 29165902 PMCID: PMC6186148 DOI: 10.1002/jbio.201700204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/19/2017] [Accepted: 11/20/2017] [Indexed: 05/10/2023]
Abstract
A single-channel high-resolution cross-polarization (CP) optical coherence tomography (OCT) system is presented for multicontrast imaging of human myocardium in one-shot measurement. The intensity and functional contrasts, including the ratio between the cross- and co-polarization channels as well as the cumulative retardation, are reconstructed from the CP-OCT readout. By comparing the CP-OCT results with histological analysis, it is shown that the system can successfully delineate microstructures in the myocardium and differentiate the fibrotic myocardium from normal or ablated myocardium based on the functional contrasts provided by the CP-OCT system. The feasibility of using A-line profiles from the 2 orthogonal polarization channels to identify fibrotic myocardium, normal myocardium and ablated lesion is also discussed.
Collapse
Affiliation(s)
- Xinwen Yao
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Yu Gan
- Department of Electrical Engineering, Columbia University, New York, New York
| | - Yuye Ling
- 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
| |
Collapse
|
23
|
Iskander-Rizk S, Kruizinga P, van der Steen AFW, van Soest G. Spectroscopic photoacoustic imaging of radiofrequency ablation in the left atrium. BIOMEDICAL OPTICS EXPRESS 2018; 9:1309-1322. [PMID: 29541523 PMCID: PMC5846533 DOI: 10.1364/boe.9.001309] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 05/20/2023]
Abstract
Catheter-based radiofrequency ablation for atrial fibrillation has long-term success in 60-70% of cases. A better assessment of lesion quality, depth, and continuity could improve the procedure's outcome. We investigate here photoacoustic contrast between ablated and healthy atrial-wall tissue in vitro in wavelengths spanning from 410 nm to 1000 nm. We studied single- and multi-wavelength imaging of ablation lesions and we demonstrate that a two-wavelength technique yields precise detection of lesions, achieving a diagnostic accuracy of 97%. We compare this with a best single-wavelength (640 nm) analysis that correctly identifies 82% of lesions. We discuss the origin of relevant spectroscopic features and perspectives for translation to clinical imaging.
Collapse
Affiliation(s)
- Sophinese Iskander-Rizk
- Biomedical Engineering Department, Thorax Center-Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Pieter Kruizinga
- Biomedical Engineering Department, Thorax Center-Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- ImPhys, Faculty of Applied Sciences, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
| | - Antonius F. W. van der Steen
- Biomedical Engineering Department, Thorax Center-Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- ImPhys, Faculty of Applied Sciences, Delft University of Technology, Lorentzweg 1, 2628 CJ Delft, The Netherlands
| | - Gijs van Soest
- Biomedical Engineering Department, Thorax Center-Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| |
Collapse
|
24
|
Goergen CJ, Chen HH, Sakadžić S, Srinivasan VJ, Sosnovik DE. Microstructural characterization of myocardial infarction with optical coherence tractography and two-photon microscopy. Physiol Rep 2017; 4:4/18/e12894. [PMID: 27650248 PMCID: PMC5037910 DOI: 10.14814/phy2.12894] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/07/2016] [Indexed: 11/24/2022] Open
Abstract
Myocardial infarction leads to complex changes in the fiber architecture of the heart. Here, we present a novel optical approach to characterize these changes in intact hearts in three dimensions. Optical coherence tomography (OCT) was used to derive a depth‐resolved field of orientation on which tractography was performed. Tractography of healthy myocardium revealed a smooth linear transition in fiber inclination or helix angle from the epicardium to endocardium. Conversely, in infarcted hearts, no coherent microstructure could be identified in the infarct with OCT. Additional characterization of the infarct was performed by the measurement of light attenuation and with two‐photon microscopy. Myofibers were imaged using autofluorescence and collagen fibers using second harmonic generation. This revealed the presence of two distinct microstructural patterns in areas of the infarct with high light attenuation. In the presence of residual myofibers, the surrounding collagen fibers were aligned in a coherent manner parallel to the myofibers. In the absence of residual myofibers, the collagen fibers were randomly oriented and lacked any microstructural coherence. The presence of residual myofibers thus exerts a profound effect on the microstructural properties of the infarct scar and consequently the risk of aneurysm formation and arrhythmias. Catheter‐based approaches to segment and image myocardial microstructure in humans are feasible and could play a valuable role in guiding the development of strategies to improve infarct healing.
Collapse
Affiliation(s)
- Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Howard H Chen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Sava Sakadžić
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts
| | - Vivek J Srinivasan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts Department of Biomedical Engineering, University of California Davis, Davis, California
| | - David E Sosnovik
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital Harvard Medical School, Charlestown, Massachusetts
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Gan Y, Tsay D, Amir SB, Marboe CC, Hendon CP. Automated classification of optical coherence tomography images of human atrial tissue. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:101407. [PMID: 26926869 PMCID: PMC5995000 DOI: 10.1117/1.jbo.21.10.101407] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/05/2016] [Indexed: 05/02/2023]
Abstract
Tissue composition of the atria plays a critical role in the pathology of cardiovascular disease, tissue remodeling, and arrhythmogenic substrates. Optical coherence tomography (OCT) has the ability to capture the tissue composition information of the human atria. In this study, we developed a region-based automated method to classify tissue compositions within human atria samples within OCT images. We segmented regional information without prior information about the tissue architecture and subsequently extracted features within each segmented region. A relevance vector machine model was used to perform automated classification. Segmentation of human atrial ex vivo datasets was correlated with trichrome histology and our classification algorithm had an average accuracy of 80.41% for identifying adipose, myocardium, fibrotic myocardium, and collagen tissue compositions.
Collapse
Affiliation(s)
- Yu Gan
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - David Tsay
- Columbia NY Presbyterian Hospital, 630 West 168th Street, New York, New York 10032, United States
| | - Syed B. Amir
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - Charles C. Marboe
- Columbia University Medical Center, 630 West 168th Street, New York, New York 10032, United States
| | - Christine P. Hendon
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| |
Collapse
|
27
|
Yao X, Gan Y, Marboe CC, Hendon CP. Myocardial imaging using ultrahigh-resolution spectral domain optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:61006. [PMID: 27001162 PMCID: PMC4814547 DOI: 10.1117/1.jbo.21.6.061006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/29/2016] [Indexed: 05/17/2023]
Abstract
We present an ultrahigh-resolution spectral domain optical coherence tomography (OCT) system in 800 nm with a low-noise supercontinuum source (SC) optimized for myocardial imaging. The system was demonstrated to have an axial resolution of 2.72 μm with a large imaging depth of 1.78 mm and a 6-dB falloff range of 0.89 mm. The lateral resolution (5.52 μm) was compromised to enhance the image penetration required for myocardial imaging. The noise of the SC source was analyzed extensively and an imaging protocol was proposed for SC-based OCT imaging with appreciable contrast. Three-dimensional datasets were acquired ex vivo on the endocardium side of tissue specimens from different chambers of fresh human and swine hearts. With the increased resolution and contrast, features such as elastic fibers, Purkinje fibers, and collagen fiber bundles were observed. The correlation between the structural information revealed in the OCT images and tissue pathology was discussed as well.
Collapse
Affiliation(s)
- Xinwen Yao
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - Yu Gan
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| | - Charles C Marboe
- Columbia University Medical Center, Department of Pathology and Cell Biology, 630 West 168th Street, New York, New York 10032, United States
| | - Christine P Hendon
- Columbia University, Department of Electrical Engineering, 500 West 120th Street, New York, New York 10027, United States
| |
Collapse
|