Integrated RFA/PSOCT catheter for real-time guidance of cardiac radio-frequency ablation

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.

Imaging of subendocardial adipose tissue and fiber orientation distributions in the human left atrium using optical coherence tomography

“…Several studies have demonstrated the development of OCT‐integrated catheters that may be useful for ablation guidance, in vivo. With OCT's video‐rate imaging speeds and high resolution, these studies have focused on the application of using OCT‐integrated catheters to monitor ablation lesion formation in real‐time . In addition to imaging lesions, OCT‐integrated catheters could simultaneously provide a real‐time, high‐resolution characterization of the left atrial tissue structure.…”

“…16 these studies have focused on the application of using OCTintegrated catheters to monitor ablation lesion formation in realtime. [3][4][5][6]18,19 In addition to imaging lesions, OCT-integrated catheters could simultaneously provide a real-time, high-resolution characterization of the left atrial tissue structure. However, there exists a lack of OCT data over the human left atrium to inform this application.…”

“…In recent years, optical coherence tomography (OCT) has been demonstrated to have the potential to provide real‐time imaging guidance during ablation through the use of OCT‐integrated catheters. OCT imaging has been able to distinguish ablation lesions from untreated tissue, as well as identify disruptions in the myocardium and endocardium indicative of overtreatment . Preliminary in vivo imaging studies have captured OCT images of endocardial and myocardial features within beating swine hearts …”

“…OCT imaging has been able to distinguish ablation lesions from untreated tissue, as well as identify disruptions in the myocardium and endocardium indicative of overtreatment. [2][3][4][5] Preliminary in vivo imaging studies have captured OCT images of endocardial and myocardial features within beating swine hearts. 3,6 In addition to tracking lesion formation, however, OCT could provide valuable information on tissue architecture by high-resolution imaging of the atrial wall.…”

Characterization of the human myocardium by optical coherence tomography

“…Comprehensive OCT imaging of the human pulmonary veins has visualized collagen fibers in the venous myocardial sleeves, including varying organization among different veins . Finally, OCT‐integrated catheters have been developed for the monitoring of lesion formation during ablation procedures for atrial fibrillation, with some demonstrations in vivo . Therefore, OCT may be able to offer real‐time visualization during catheter‐based therapies.…”