Development of an Electrophysiology (EP)-Enabled Intracardiac Ultrasound Catheter Integrated With NavX 3-Dimensional Electrofield Mapping for Guiding Cardiac EP Interventions

Li, Xiao Kui; Pemberton, James; Thomenius, Kai E.; Dentinger, Aaron; Lowe, Robert I.; Ashraf, Muhammad; Shung, K. Kirk; Chia, R.; Stephens, Douglas N.; O’Donnell, Matthew; Mahajan, Aman; Balaji, Seshadri; Shivkumar, Kalyanam; Sahn, David J.

doi:10.7863/jum.2007.26.11.1565

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…A single‐ring electrode very near the catheter tip was used as the active EAM electrode; the catheter tip could be tracked in any position within the porcine heart right atrial and right ventricular chambers. The NavX EAM system was used as in previous studies 14 , 44 to maintain a spatial map of the ablation sites visited. After the specific site ablation studies, the porcine heart was explanted and examined (Figure 7).…”

Section: Resultsmentioning

confidence: 99%

First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

Stephens¹,

Truong²,

Nikoozadeh³

et al. 2012

J of Ultrasound Medicine

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Objectives The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. Methods The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. Results The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Conclusions Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures.

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Section: Resultsmentioning

confidence: 99%

First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

Stephens¹,

Truong²,

Nikoozadeh³

et al. 2012

J of Ultrasound Medicine

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“…An integrated diagnostic electrophysiology catheter design was reported previously. 27 This particular catheter employed frequencies ranging between 8 MHz and 15 MHz and boasted 4 cm to 6 cm of tissue penetration. Lateral resolution was reported as being 0.2 mm.…”

Section: Discussionmentioning

confidence: 99%

Imaging of Atrioventricular Nodal Conduction Tissue in Porcine Hearts Using Optical Coherence Tomography

Kilinc

Zhao

Jenkins

et al. 2019

J Innov Cardiac Rhythm Manage.

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Optical coherence tomography (OCT) employs near-infrared light to image the microstructure of different tissues. Clinically, it has been used to image the walls of coronary arteries. In research settings, one of the applications for OCT is visualizing endocardial and subendocardial structures. The present experiment sought to determine whether OCT can identify native conduction tissues in adult porcine hearts. During the study, the right atrial endocardial surfaces of excised adult porcine hearts were exposed. The triangle of Koch was imaged with the OCT system and the conduction tissue was identified. The area was then prepared for histologic examination with Masson's trichrome stain. The results of histologic preparations and OCT images were then compared. Ultimately, nine porcine hearts were examined using this methodology. OCT imaging successfully identified subendocardial structures presumed to be the compact atrioventricular node. Histologic images of the preparations delineated the different tissue types and conduction tissue was easily identified. The location of distinctive hyporeflective areas in the OCT images correlated with the location of conduction tissue in the histology images. In light of the findings of this study, it is suggested that atrioventricular nodal tissue can be identified by OCT in freshly dissected unfixed porcine hearts. OCT images distinguished the differentiated conduction tissue in close proximity with the endocardium, myofibers, and fibrous tissue, and the success of this was verified with histology. This technology may be useful for the direct visualization of the native conduction system during procedures in the operating room and electrophysiology laboratory. Further studies with perfused tissue samples and live animal experiments are needed to better assess the efficacy of this novel application.

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“…Intracardiac ultrasound catheters, used for real-time imaging during the EP intervention, have recently been integrated with EAM. (9)(10)(11)(12)(13). Robotic catheter manipulators have also been integrated (14).…”

Section: Imaging Modalities Integrated With Eam Systems In the Ep Suitementioning

confidence: 99%

Voltage‐based device tracking in a 1.5 tesla MRI during imaging: initial validation in swine models

Schmidt

Tse

Reichlin

et al. 2013

Magnetic Resonance in Med

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Purpose Voltage-based device-tracking (VDT) systems are commonly used for tracking invasive devices in electrophysiological (EP) cardiac-arrhythmia therapy. During EP procedures, electro-anatomic-mapping (EAM) workstations provide guidance by integrating VDT location and intra-cardiac-ECG information with X-ray, CT, Ultrasound, and MR images. MR assists navigation, mapping and radio-frequency-ablation. Multi-modality interventions require multiple patient transfers between an MRI and the X-ray/ultrasound EP suite, increasing the likelihood of patient-motion and image mis-registration. An MRI-compatible VDT system may increase efficiency, since there is currently no single method to track devices both inside and outside the MRI scanner. Methods An MRI-compatible VDT system was constructed by modifying a commercial system. Hardware was added to reduce MRI gradient-ramp and radio-frequency-unblanking-pulse interference. VDT patches and cables were modified to reduce heating. Five swine cardiac VDT EAM-mapping interventions were performed, navigating inside and thereafter outside the MRI. Results Three-catheter VDT interventions were performed at >12 frames-per-second both inside and outside the MRI scanner with <3mm error. Catheters were followed on VDT- and MRI-derived maps. Simultaneous VDT and imaging was possible in repetition-time (TR) >32 msec sequences with <0.5mm errors, and <5% MRI SNR loss. At shorter TRs, only intra-cardiac-ECG was reliable. RF Heating was <1.5C°. Conclusion An MRI-compatible VDT system is feasible.

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Development of an Electrophysiology (EP)-Enabled Intracardiac Ultrasound Catheter Integrated With NavX 3-Dimensional Electrofield Mapping for Guiding Cardiac EP Interventions

Abstract: This new technology is a first step in the integration of ICE with EP procedures.

Cited by 5 publications

References 22 publications

First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

Imaging of Atrioventricular Nodal Conduction Tissue in Porcine Hearts Using Optical Coherence Tomography

Voltage‐based device tracking in a 1.5 tesla MRI during imaging: initial validation in swine models

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