KEYWORDS: Optical coherence tomography, Tissue optics, In vivo imaging, Heart, Fluoroscopy, Visualization, Tissues, Safety, Real time imaging, Ionizing radiation
Transseptal puncture (TSP) is commonly conducted under the guidance of fluoroscopy and/or intracardiac echocardiography (ICE) at the fossa ovalis (FO) to gain percutaneous access to the left atrium for intracardiac procedures. Issues with traditional TSP include: additional vascular access through a sheath, and fluoroscopy exposes patients to ionizing radiation. TSP, if not done appropriately can result in serious complications. We studied the feasibility of optical coherence tomography (OCT) guidance of TSP with ex vivo and in vivo experiments. Results show that OCT can provide detailed structure information to identify FO allowing for safe TSP.
Significance: Pulmonary vein isolation with catheter-based radiofrequency ablation (RFA) is carried out frequently to treat atrial fibrillation. However, RFA lesion creation is only guided by indirect information (e.g., temperature, impedance, and contact force), which may result in poor lesion quality (e.g., nontransmural) and can lead to reoccurrence or complications.
Aim: The feasibility of guiding intracardiac RFA with an integrated polarization-sensitive optical coherence tomography (PSOCT)-RFA catheter in the right atria (RA) of living swine is demonstrated.
Approach: In total, 12 sparse lesions were created in the RA of three living swine using an integrated PSOCT-RFA catheter with standard ablation protocol. PSOCT images were displayed in real time to guide catheter-tissue apposition. After experiments, post-processed PSOCT images were analyzed to assess lesion quality and were compared with triphenyltetrazolium chloride (TTC) lesion quality analysis.
Results: Five successful lesions identified with PSOCT images were all confirmed by TTC analysis. In two ablations, PSOCT imaging detected gas bubble formation, indicating overtreatment. Unsuccessful lesions observed with PSOCT imaging were confirmed by TTC analysis.
Conclusions: The results demonstrate that the PSOCT-RFA catheter provides real-time feedback to guide catheter-tissue apposition, monitor lesion quality, and possibly help avoid complications due to overtreatment, which may enable more effective and safer RFA treatment.
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