Abstract
Atrial fibrillation (Afib) can lead to life threatening conditions such as heart failure and stroke. During Afib treatment, clinicians aim to repress unusual electrical activity by electrically isolating the pulmonary veins (PV) from the left atrium (LA) using radiofrequency ablation. However, current clinical tools are limited in reliably assessing transmurality of the ablation lesions and detecting the presence of gaps within ablation lines, which can warrant repeat procedures. In this study, we developed an endoscopic multispectral reflectance imaging (eMSI) system for enhanced discrimination of tissue treatment at the PV junction. The system enables direct visualization of cardiac lesions through an endoscope at acquisition rates up to 25 Hz. Five narrowband, high-power LEDs were used to illuminate the sample (450, 530, 625, 810 and 940nm) and combinatory parameters were calculated based on their relative reflectance. A stitching algorithm was employed to generate large field-of-view, multispectral mosaics of the ablated PV junction from individual eMSI images. A total of 79 lesions from 15 swine hearts were imaged, ex vivo. Statistical analysis of the acquired five spectral data sets and ratiometric maps revealed significant differences between transmural lesions, non-transmural lesions around the venoatrial junctions, unablated posterior wall of left atrium tissue, and pulmonary vein (p < 0.0001). A pixel-based quadratic discriminant analysis classifier was applied to distinguish four tissue types: PV, untreated LA, non-transmural and transmural lesions. We demonstrate tissue type classification accuracies of 80.2% and 92.1% for non-transmural and transmural lesions, and 95.0% and 92.8% for PV and untreated LA sites, respectively. These findings showcase the potential of eMSI for lesion validation and may help to improve AFib treatment efficacy.
Highlights
Atrial fibrillation (AFib) is the most common arrhythmia and afflicts more than 2.2 million people-in the United States [1]
A catheter is inserted through the femoral vein and a transseptal puncture is used to advance the catheter to the left atrium to ablate areas of the myocardium that trigger abnormal electrical activity, primarily around the pulmonary veins (PV)
We present the development of an endoscopic multispectral reflectance imaging system for discriminating fully transmural lesions from normal and nontransmural ablation of the left atria porcine tissues
Summary
Atrial fibrillation (AFib) is the most common arrhythmia and afflicts more than 2.2 million people-in the United States [1]. Minimally invasive strategies such as catheter ablation are performed to restore sinus rhythm. In such cases, a catheter is inserted through the femoral vein and a transseptal puncture is used to advance the catheter to the left atrium to ablate areas of the myocardium that trigger abnormal electrical activity, primarily around the PV. Clinicians lack the intraprocedural imaging tools to visualize in real time, the precise location and depth of lesions. They indirectly monitor formation of ablation lesions through, drop in impedance, contact force, ablation time using force time integral from ablation catheter [16]. Direct assessment of lesion quality through endoscopic images may help improve distinguishing incomplete lesions and assessing ablation line continuity
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