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.
Highlights
In the past two decades, cardiac arrhythmias have become one of the direst public health issues and a major cause of health care expenditure in western countries [1]
We have shown that the loss of birefringence in cardiac tissue, which can be detected by polarization sensitive optical coherence tomography (PSOCT), is a strong marker of thermal ablation and has the potential to provide feedback during lesion formation [22, 26, 27]
We demonstrate an integrated 2.3mm (7 Fr) diameter radiofrequency ablation (RFA)/optical coherence tomography (OCT) catheter for monitoring RFA procedures with PSOCT imaging in real time
Summary
In the past two decades, cardiac arrhythmias have become one of the direst public health issues and a major cause of health care expenditure in western countries [1]. During the RFA procedure, a small catheter is guided into the heart to heat and destroy the culprit tissue that was causing abnormal electrical conduction with radiofrequency energy. This has become the standard of care for cardiac arrhythmias as it is often curative, eliminating the need for medications that potentially last a lifetime [4, 5]. Complication rates from the procedure are low, with 0.8%-6% of patients experiencing a major complication depending primarily on the type of ablation and the patient’s severity of illness [6]
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