Near-infrared reflectance spectroscopy can serve as a complementary imaging tool that accurately provides endocardial substrates through optical mapping and improves the quality of ablation therapy. Optical indices were extracted from spectrum response, visualized similarity of blood and PBS maps interpolated from those indices were evaluated. Statistical analysis between blood and PBS optical indices were performed for each substrate type, and classification algorithms were developed using key features to classify pulmonary vein, lesion, and fibrosis with high accuracy. The results indicate NIRS mapping catheters can serve as a complementary imaging tool to the current EAM systems to improve treatment efficacy.
Atrial fibrillation is a common and potentially lethal arrhythmia, yet catheter radiofrequency ablation (RFA), a mainstay of treatment, frequently fails to provide long-term remission. We present a catheter capable of near-infrared diffuse reflectance spectroscopy, with a source fiber delivering broadband light and a detection fiber whose light is sent to a spectrometer. Separate catheters have been fabricated with different source-detection separations, yielding spectra sensitive to different optical properties of the underlying tissue. Optical indices have been developed from benchtop measurements to distinguish the spectral signatures of different cardiac substrates. These measurements will equip clinicians with intraprocedural feedback to improve RFA effectiveness.
Atrial fibrillation (AF) is the most common arrhythmia worldwide. An increasingly common treatment option is catheter ablation. During this procedure, the clinician steers a catheter into the left atrium and ablates a lesion fence around the pulmonary veins, a common source of ectopic signals. This lesion fence blocks arrhythmogenic tissue from initiating an erroneous heartbeat. However, if the disease has progressed from paroxysmal to persistent, pathogenic tissue exists throughout the atrium, and common ablation schemes are not as effective. In this case, technologies exist to electroanatomically map the atrium and guide clinicians in targeting adjunctive AF ablation targets. Low voltages mapped in vivo are a well-documented way of identifying atrial fibrosis, an important substrate for AF. Ablating low voltage zones in patients with a more developed disease can help terminate AF and improve long-term outcomes, but low voltage measurements are not specific to fibrosis. Treatment results vary because the targeting that electroanatomical mapping provides is incomplete. Our group has shown that polarization-sensitive optical coherence tomography (PSOCT) and near infrared spectroscopy (NIRS) can monitor lesion formation in vivo and differentiate tissue types in the atrium. Now, we are investigating the technology’s utility in identifying AF targets prior to ablation. We have collaborated in developing a swine model of AF that shows the atria remodels during the diseased state. Because of this, we can electroanatomically map these diseased hearts in vivo to measure low voltage zones. Subsequently, we examine the left atrium ex vivo using benchtop PSOCT, NIRS, and optical mapping (OM) and register these optical measurements to the in vivo low voltage zones. We show that OM confirms abnormal conduction, while PSOCT- and NIRS-derived metrics have promise for identifying low voltage zones. We confirm these measures with histological identification of fibrosis. This suggests the feasibility of using PSOCT-NIRS at the catheter tip to detect AF ablation targets.
SignificanceRadiofrequency 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.AimCatheter-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.ApproachPorcine 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.ResultsNIRS 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.ConclusionsCatheter-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.
Patients with atrial fibrillation (AF) require detailed mapping of the left atrium (LA) during radiofrequency ablation (RFA) procedures. Identifying the lesion gaps can provide helpful guidance for complete conduction blocks, reducing the probability of recurrence. We implement anatomical mapping using an integrated optical probe with a combined modality of near-infrared spectroscopy (NIRS) and optical coherence tomography (OCT). Both spectral signatures are captured simultaneously, with the sample-sites located by a magnetic tracking sensor. With increased sampling density and speed, we are able to recognize small gaps between lesions LA, and reconstruct atrial substrate and lesion maps with the tissue underneath PBS and blood.
Atrial fibrillation (AF) is the most common arrhythmia worldwide. An increasingly common treatment option is catheter ablation. During this procedure, the electrophysiologist steers a catheter into the left atrium and ablates a lesion fence around common sources of ectopic signals. This blocks arrhythmogenic tissue from initiating an erroneous heartbeat. Technological advancements in this maturing procedure have made ablations more widespread and effective for patients, but there is still a need to improve long term efficacy of the procedure. The national rate of recurrent AF after an ablation is 20% to 40% and this is almost universally due to reconnection via poor lesion quality. With current catheter feedback available to clinicians, it is difficult to assess whether a lesion line will remain durable or heal to initiate recurrent AF. We have previously shown that polarization-sensitive optical coherence tomography (PSOCT) can monitor lesion formation in vivo during an ablation procedure. This feedback at the catheter tip may help clinicians assess lesion quality by measuring tissue changes. To further understand the technology’s utility and limitations, we are conducting experiments to characterize PSOCT detection of gaps between lesions. Lesion gaps are a common failure mode when AF recurrence is caused by reconnection. We ablate left atrial swine myocardium ex vivo and collect PSOCT images to compare with histology and identify the detection limits of small lesion gaps. Using PSOCT at the catheter tip to detect small gaps in lesion lines could help clinicians reduce recurrence by decreasing opportunities for reconnection.
In this work, we investigate the remodeling of uterine tissue that occurs during the presence of cancer. We acquired de-identified normal and tumor tissue from the Columbia University Medical Center Tissue Bank and used an optical coherence tomography (OCT) system with a 6.5-micron axial resolution to optically characterize the samples. Initial results indicate that the collagen fiber orientation in the cancerous tissue is more heterogeneous than that of the normal tissue.
An intraoperative tool that accurately provides detailed structural information and classifies endocardial substrates could help improve guidance during ablation therapy. With our custom near infrared spectroscopy-integrated radiofrequency catheter, here we demonstrate atrial substrate mapping on ex vivo swine and human left atria. Optical contrast indices and classification algorithms were developed, which classified pulmonary vein, lesion, and fibrosis using optically derived parameters based on endogenous tissue spectral signatures with high accuracy. Predicted lesion depth percentage linearly corresponded with ground truth measurements from trichrome histology. These results suggest near infrared-integrated mapping catheters can serve as a complementary tool to currently-available electroanatomical mapping systems to improve treatment efficacy.
Radiofrequency ablation (RFA) procedures require detailed mapping of atrial structure for patients with atrial fibrillation (AF). Identifying the spatial distribution and transmural properties of lesions in left atrium (LA) can provide helpful guidance to RFA treatment. We implement anatomical mapping by tracking sample-sites and capturing spectral signatures from near-infrared spectroscopy (NIRS) with an optical catheter. Using interpolation algorithm, we reconstruct atrial lesion maps of ex-vivo swine and human atriums, and evaluate the capability of NIRS to recognize spatial discontinuity of lesions.
Radiofrequency ablation procedures, such as pulmonary vein isolation for patients with atrial fibrillation, require detailed anatomical mapping of atrial structural substrate to identify AF substrate. Identification of structural substrates, such as scar tissue, pulmonary vein, collagen and adipose tissue can provide helpful guidance of RFA procedures. We demonstrate mapping of atrial substrates using optical spectral signatures from near-infrared spectroscopy. Using position tracking and interpolation algorithm, we assess the capability of NIRS to distinguish various tissue structures on a reconstructed 3D spatial maps of ex-vivo swine and human atriums.
Patients with cardiac arrythmia most commonly require radiofrequency ablation to destroy arrhythmogenic electrical pathways and restore normal heart rhythm. However, arrhythmia resurgence exists from limited means to directly confirm the extent of lesion progression during RFA procedure. Optical spectroscopy is sensitive to tissue optical properties and changes in biomolecular composition. We propose a simplified optical spectroscopy through a single fiber integrated catheter to predict irrigated endocardial lesion progression using deep neural network model on ex-vivo model.
Radiofrequency ablation is the most common procedure to treat cardiac arrythmias, such as atrial fibrillation. Catheter ablation isolates or eradicates abnormal electrical activity to maintain sinus rhythm. However, inadequate lesion formation permits arrhythmia resurgence. Optical spectroscopic signatures can detect biomolecular and tissue structural changes and can potentially serve as a tool to evaluate lesion quality. In this work, we introduce a near-infrared spectroscopy through fiber-optic integrated catheter to assess contact and predict lesion size using artificial neural network model on both ex-vivo porcine model and non-survival in-vivo pilot experiments in pigs.
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