Characteristics of Radiofrequency Catheter Ablation Lesion Formation in Real Time In Vivo Using Near Field Ultrasound Imaging

被引:27
作者
Wright, Matthew [1 ,2 ]
Harks, Erik [3 ]
Deladi, Szabolcs [3 ]
Fokkenrood, Steven [3 ]
Brink, Rob [3 ]
Belt, Harm [4 ]
Kolen, Alexander F. [4 ]
Rankin, Darrell [5 ]
Stoffregen, William [5 ]
Cockayne, Debra A. [5 ]
Cefalu, Joseph [5 ]
Haines, David E. [6 ,7 ]
机构
[1] Kings Coll London, Div Imaging Sci & Biomed Engn, London, England
[2] St Thomas Hosp, Dept Cardiol, London, England
[3] Philips Healthcare, Best, Netherlands
[4] Philips Res, Eindhoven, Netherlands
[5] Boston Sci Corp, San Jose, CA USA
[6] Beaumont Hlth Syst, Dept Cardiovasc Med, Royal Oak, MI USA
[7] Oakland Univ, William Beaumont Sch Med, Royal Oak, MI 48073 USA
关键词
catheter ablation; lesion formation; ultrasound; atrial fibrillation;
D O I
10.1016/j.jacep.2018.04.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES Visualizing myocardium with near field ultrasound (NFUS) transducers in the tip of the catheter might provide an image of the evolving pathological lesion during energy delivery. BACKGROUND Radiofrequency (RF) catheter ablation has been effective in arrhythmia treatment, but no technology has allowed lesion formation to be visualized in real time in vivo. METHODS RF catheter ablations were performed in vivo with the goal to create transmural atrial lesions and large ventricular lesions. RF lesion formation was imaged in real time using M-mode, tissue Doppler, and strain rate information from the NFUS open irrigated RF ablation catheter incorporating 4 ultrasound transducers (1 axial and 3 radial), and growth kinetics were analyzed. Nineteen dogs underwent ablation in the right and left atria (n = 185), right ventricle (n = 67), and left ventricle (n = 66). Lesions were echolucent with tissue strain rate by NFUS. RESULTS Lesion growth frequently progressed from epicardium to endocardium in thin-walled tissue. The half time of lesion growth was 5.5 +/- 2.8 s in thin-walled and 9.7 +/- 4.3 s in thick-walled tissue. Latency of lesion onset was seen in 57% of lesions ranging from 1 to 63.8 s. Tissue edema (median 25% increased wall thickness) formed immediately upon lesion formation in 83%, and intramyocardial steam was seen in 71% of cases. CONCLUSIONS NFUS was effective in imaging RF catheter ablation lesion formation in real time. It was useful in assessing the dynamics of lesion growth and could visualize impending steam pops. It may be a useful technology to improve both safety and efficacy of RF catheter ablation. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:1062 / 1072
页数:11
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