Polarization-sensitive optical coherence tomography monitoring of percutaneous radiofrequency ablation in left atrium of living swine

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.

Polarization-Sensitive Optical Coherence Tomography (PSOCT) for identifying and analyzing gaps in lesion lines during ex vivo simulated radiofrequency ablation procedure

“…We have already shown that PSOCT at the tip of an ablation catheter can provide more information and feedback for determining lesion transmurality [12][13][14] . We have designed and built a cardiac ablation catheter with PSOCT.…”

Needle guidance with Doppler-tracked polarization-sensitive optical coherence tomography

“…PS-OCT reveals tissue birefringence features that are invisible to structural (non-PS) OCT imaging. PS-OCT has been used to image skeletal muscle, 17 heart, 18 , 19 and brain. 20 In all of these procedures, PS-OCT was added to a scanned-beam approach.…”

Monitoring of irrigated lesion formation with single fiber based multispectral system using machine learning

“…Several groups have adopted optical methods to directly visualize lesion delivery and to predict lesion dimensions [14][15][16]. Catheter based optical coherence tomography (OCT) allows immediate imaging feedback to monitor RF lesion formation [14,[17][18][19][20][21][22]. In photoacoustic imaging, real-time assessment of RF ablation lesion formation in the left atrium was demonstrated with clinically translatable instruments [23].…”