Early human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation

Anh, Daejoon; Chen, Henry A.; Eversull, Christian S.; Mourlas, Nicholas J.; Mead, R. Hardwin; Liem, L. Bing; Hsia, Henry H.; Wang, Paul J.; Al‐Ahmad, Amin

doi:10.1016/j.hrthm.2006.04.029

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…The technique, also suitable for Langendorff-perfused hearts, is scalable and less expensive than traditional optical mapping methods. In contrast to the single previous report on in vivo optical mapping [8], our system is adaptable, in principle, to trans-catheter endoscopic methods, such as used to visualize the endocardium in humans [15], [16], [17], [18], opening the door to clinical development as an arrhythmia mapping tool.…”

Section: Discussionmentioning

confidence: 99%

“…In the isolated heart preparation, mechanical restriction or ratiometric imaging with post-acquisition motion tracking has been shown to significantly reduce motion artifacts, but imaging a strongly contracting whole-heart is still an unsolved problem [9]. Indeed, an even simpler approach has been used with direct visualization catheters where local mechanical immobilization by the endocardial balloon successfully limits motion artifacts [17], even as applied to high resolution laser based ablation in patients [25]. Third, while we found no evidence of short-term detrimental effects of di-4-ANBDQPQ, long term toxicity studies need to be done.…”

Section: Discussionmentioning

confidence: 99%

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In Situ Optical Mapping of Voltage and Calcium in the Heart

et al. 2012

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Electroanatomic mapping the interrelation of intracardiac electrical activation with anatomic locations has become an important tool for clinical assessment of complex arrhythmias. Optical mapping of cardiac electrophysiology combines high spatiotemporal resolution of anatomy and physiological function with fast and simultaneous data acquisition. If applied to the clinical setting, this could improve both diagnostic potential and therapeutic efficacy of clinical arrhythmia interventions. The aim of this study was to explore this utility in vivo using a rat model. To this aim, we present a single-camera imaging and multiple light-emitting-diode illumination system that reduces economic and technical implementation hurdles to cardiac optical mapping. Combined with a red-shifted calcium dye and a new near-infrared voltage-sensitive dye, both suitable for use in blood-perfused tissue, we demonstrate the feasibility of in vivo multi-parametric imaging of the mammalian heart. Our approach combines recording of electrophysiologically-relevant parameters with observation of structural substrates and is adaptable, in principle, to trans-catheter percutaneous approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In Situ Optical Mapping of Voltage and Calcium in the Heart

et al. 2012

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“…A visible light source is also housed in the device handle and is conveyed distally by fiber optics to illuminate the visualization field. We have previously described the use of this catheter for imaging the coronary sinus, thebesian and vieussens valves, and other intracardiac structures [11]. Video output from the device was routed through a Sony GVD-1000DV VCR to a standard LCD monitor.…”

Section: Methodsmentioning

confidence: 99%

Direct Visualization of Cardiac Radiofrequency Ablation Lesions

Eversull

Lin

Irani

et al. 2009

J. of Cardiovasc. Trans. Res.

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Effective ablation of atrial fibrillation and other cardiac arrhythmias requires precise catheter navigation and controlled delivery of energy to cardiac tissue. In this study, we summarize our initial experience using a fiber optic direct visualization catheter to evaluate and guide placement of endocardial radiofrequency (RF) ablation lesions. RF lesions were created in cadaveric porcine hearts and examined in a blood-filled field using a direct visualization catheter. Direct visualization of RF lesions was repeated in vivo using an ovine model. Lesions and interlesion gaps were clearly identifiable using the direct visualization catheter. It was possible to place lesions in proximity to anatomical landmarks and in relation to one another. Catheter-generated images correlated well with lesion appearance on gross examination. Direct catheter-based visualization is a feasible technique for guiding RF lesion placement, estimating lesion size, and identifying interlesion gaps. Future work is needed to correlate surface appearance with transmurality and electrical isolation.

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“…The ability to directly visualize the obstacles may improve the ability to overcome them as well as limit the time spent struggling with implantation based on fluoroscopy and general knowledge of loca- tion of the coronary sinus. 51 Another catheter that allows visualization by an attempt to filter out red blood cells has been used clinically and can reveal side branches without the need of contrast (Figure 4). This catheter can deliver some remarkable images, but it is unreliable.…”

Section: Technological Advancesmentioning

confidence: 99%

Interventional Electrophysiology and Cardiac Resynchronization Therapy

Burkhardt

Wilkoff

2007

Circulation

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Abstract-Implantable devices have become a readily available option for patients with heart failure. Not only do these patients develop bradycardia and ventricular tachycardia, but their ventricular dysfunction can often improve with cardiac resynchronization therapy. However, this is a complex and rapidly developing clinical science for which the physician chooses techniques and selects patients on the basis of the results of clinical trials, clinical experience, and rapidly evolving tools. The results depend on the interplay of these complex variables. Placement of the left ventricular lead has forced the device physician to develop new skills and/or interdisciplinary relationships with physicians with vascular intervention, imaging, and surgical skills. Familiarity with the cardiac venous anatomy, occlusive venography, venoplasty, guide wire tools, guiding catheters, stenting, and new intracardiac visualization and magnetic intracardiac lead positioning tools are examples of just a few of the novel skills that are useful in the delivery of cardiac resynchronization therapy. Beyond implantation, these patients and devices require specialized follow-up with continued medical therapy and echo-guided adjustments of device programming. Finally, there are ongoing controversies and many as yet unanswered questions that are the subject of ongoing and planned clinical trials. (Circulation. 2007;115:2208-2220.)Key Words: electrical stimulation Ⅲ heart failure Ⅲ pacemakers Ⅲ defibrillators, implantable P atients with advanced congestive heart failure (CHF) on maximal medical therapy have had very limited options until recently. The advent of cardiac resynchronization therapy (CRT) has revolutionized the treatment of these patients. Many patients with advanced CHF demonstrate dyssynchrony by evidence of a widened QRS complex on the EKG. Most frequently this takes the form of a left bundle-branch block morphology, but right bundle-branch block morphology and intraventricular conduction delay are also less frequently present. 1,2 Electrical dyssynchrony usually implies that different portions of the ventricle contract at different times, unlike that of a normal heart in which contraction of all segments is nearly simultaneous. The presence of a widened QRS itself in the presence of CHF symptoms is associated with increased mortality. 3,4 Dyssynchrony on EKG, particularly of the left bundle-branch type, is associated with delayed activation of the left lateral wall, mitral regurgitation, impaired left ventricular filling, and reduced measures of cardiac contractility. 5-8 CRT operates on the premise that attempts to normalize the timing of activation of the left and right ventricle or lateral wall and septum may improve the consequences of this impaired activation. 9 Multiple trials have shown that CRT improves heart failure symptoms in the majority of recipients. 10 -14 These trials include the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) trial, which studied 453 patients. All patients had a CRT device impla...

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Early human experience with use of a deflectable fiberoptic endocardial visualization catheter to facilitate coronary sinus cannulation

Cited by 19 publications

References 19 publications

In Situ Optical Mapping of Voltage and Calcium in the Heart

In Situ Optical Mapping of Voltage and Calcium in the Heart

Direct Visualization of Cardiac Radiofrequency Ablation Lesions

Interventional Electrophysiology and Cardiac Resynchronization Therapy

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