Catheter Ablation Lesion Visualization With Intracardiac Strain Imaging in Canines and Humans

Sayseng, Vincent; Grondin, Julien; Salgaonkar, Vasant A.; Grubb, Christopher S.; Basij, Maryam; Mehrmohammadi, Mohammad; Iyer, Vivek; Wang, Daniel; Garan, Hasan; Wan, Elaine; Konofagou, Elisa E.

doi:10.1109/tuffc.2020.2987480

Cited by 6 publications

(3 citation statements)

References 43 publications

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“… 15 In human medicine, ICE is commonly used in interventional cardiology for adequate guidance of, for example, endocardial ablation, transseptal puncture for LA access, or percutaneous intracardiac defect closure. 15 , 16 In dogs, ICE is mainly applied in experimental settings, 17 , 18 , 19 with only a few clinical reports. 20 , 21 The use of ICE in horses remains anecdotal.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale

Vernemmen

Paulussen

Dauvillier³

et al. 2022

Veterinary Internal Medicne

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This case report describes the 2-dimensional transthoracic (2D-TTE), 3-dimensional transthoracic (3D-TTE) and intracardiac echocardiographic (ICE) characterization of the fossa ovalis region in 2 horses. The first case was presented for poor performance and showed an anechoic zone in the interatrial septum on 2D-TTE. Based on 3D-TTE a deepened fossa ovalis could be identified and using ICE the presence of an interatrial shunt could be excluded. The second case was referred for a cardiac murmur and the presence of turbulent flow in and around the interatrial septum on 2D-TTE color flow Doppler. The complementary use of 2D-TTE, 3D-TTE, and ICE allowed detailed characterization of a patent foramen ovale, with evidence of a left-to-right shunt in a dorsocranial to ventrocaudal direction with limited hemodynamic implications. These 2 cases underline the feasibility of 3D-TTE and ICE in horses and especially show the added value of ICE in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale

Vernemmen

Paulussen

Dauvillier³

et al. 2022

Veterinary Internal Medicne

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“…Echogenicity of the substrate may provide a rough estimate of tissues characteristics and thickness and strain-based imaging techniques have shown promising results for real-time ablation lesion visualisation. 66 …”

Section: Outlook: Imaging Guided Rf Energy Titrationmentioning

confidence: 99%

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Tonko,

Silberbauer,

Mann

2023

Europace

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Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann’s bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical ‘cut-and-sew’ techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.

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“…This led to the recent study investigating the use of strain imaging from intracardiac echocardiography (ICE) catheters, which are used in ablations to visualize the left atrium and navigate the ablation catheter. 11 While this method is promising, it is currently limited to one-dimensional ultrasound and requires careful alignment of the imaging plane with the predominant direction of myocardial motion at the site of the lesions. This is particularly challenging for the operator given the constant rotation and contraction of the myocardium with the heart cycle and limitations on positioning of the ICE catheter within the atrium.…”

Section: Introductionmentioning

confidence: 99%

Cyclic Variation of Spectral Parameters for the Differentiation of Atrial Myocardium Before and Immediately Following Radiofrequency Ablation

et al. 2021

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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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Catheter Ablation Lesion Visualization With Intracardiac Strain Imaging in Canines and Humans

Cited by 6 publications

References 43 publications

Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale

Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Cyclic Variation of Spectral Parameters for the Differentiation of Atrial Myocardium Before and Immediately Following Radiofrequency Ablation

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