Abstract

Effects of radiofrequency ablation (RFA) treatment of atrial fibrillation can be limited by the ability to characterize the tissue in contact. Parameters obtained by conventional catheters, such as impedance and temperature can be insufficient in providing physiological information pertaining to effective treatment. In this report, we present a near-infrared spectroscopy (NIRS)-integrated catheter capable of extracting tissue optical properties. Validation experiments were first performed in tissue phantoms with known optical properties. We then apply the technique for characterization of myocardial tissues in swine and human hearts, ex vivo. Additionally, we demonstrate the recovery of critical parameters relevant to RFA therapy including contact verification, and lesion transmurality. These findings support the application of NIRS for improved guidance in RFA therapeutic interventions.

© 2015 Optical Society of America

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  1. A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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2014 (6)

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
[Crossref] [PubMed]

S. Nazarian and R. Beinart, “CMR-guided targeting of gaps after initial pulmonary vein isolation,” JACC Cardiovasc. Imaging 7(7), 664–666 (2014).
[Crossref] [PubMed]

E. R. Cosman, J. R. Dolensky, and R. A. Hoffman, “Factors that affect radiofrequency heat lesion size,” Pain Med. 15(12), 2020–2036 (2014).
[Crossref] [PubMed]

D. Sánchez-Quintana, J. R. López-Mínguez, Y. Macías, J. A. Cabrera, and F. Saremi, “Left atrial anatomy relevant to catheter ablation,” Cardiol. Res. Pract. 2014, 289720 (2014).
[Crossref] [PubMed]

R. P. Singh-Moon, D. M. Roblyer, I. J. Bigio, and S. Joshi, “Spatial mapping of drug delivery to brain tissue using hyperspectral spatial frequency-domain imaging,” J. Biomed. Opt. 19(9), 096003 (2014).
[Crossref] [PubMed]

X. Fu, Z. Wang, H. Wang, Y. T. Wang, M. W. Jenkins, and A. M. Rollins, “Fiber-optic catheter-based polarization-sensitive OCT for radio-frequency ablation monitoring,” Opt. Lett. 39(17), 5066–5069 (2014).
[Crossref] [PubMed]

2013 (3)

Y. Gan and C. P. Fleming, “Extracting three-dimensional orientation and tractography of myofibers using optical coherence tomography,” Biomed. Opt. Express 4(10), 2150–2165 (2013).
[Crossref] [PubMed]

S. L. Jacques, “Optical properties of biological tissues: a review,” Phys. Med. Biol. 58(11), R37–R61 (2013).
[Crossref] [PubMed]

J. Dewire and H. Calkins, “Update on atrial fibrillation catheter ablation technologies and techniques,” Nat. Rev. Cardiol. 10(10), 599–612 (2013).
[Crossref] [PubMed]

2012 (2)

H. W. Tan, X. H. Wang, H. F. Shi, L. Zhou, J. N. Gu, and X. Liu, “Left atrial wall thickness: anatomic aspects relevant to catheter ablation of atrial fibrillation,” Chin. Med. J. (Engl.) 125(1), 12–15 (2012).
[PubMed]

M. Mercader, L. Swift, S. Sood, H. Asfour, M. Kay, and N. Sarvazyan, “Use of endogenous NADH fluorescence for real-time in situ visualization of epicardial radiofrequency ablation lesions and gaps,” Am. J. Physiol. Heart Circ. Physiol. 302(10), H2131–H2138 (2012).
[Crossref] [PubMed]

2011 (5)

H. Wang, W. Kang, T. Carrigan, A. Bishop, N. Rosenthal, M. Arruda, and A. M. Rollins, “In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation,” J. Biomed. Opt. 16(11), 110505 (2011).
[Crossref] [PubMed]

R. Beinart, S. Abbara, A. Blum, M. Ferencik, K. Heist, J. Ruskin, and M. Mansour, “Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation,” J. Cardiovasc. Electrophysiol. 22(11), 1232–1236 (2011).
[Crossref] [PubMed]

C. P. Fleming, N. Rosenthal, A. M. Rollins, and M. Arruda, “First in vivo real-time imaging of endocardial radiofrequency ablation by optical coherence tomography: implications on safety and the birth of “electro-structural” substrate-guided ablation,” The Journal of Innovations in Cardiac Rhythm Management 2,199–201 (2011).

M. A. Wood, “Exposing gaps in linear radiofrequency lesions: form before function,” Circ Arrhythm Electrophysiol 4(3), 257–259 (2011).
[Crossref] [PubMed]

M. Wright, E. Harks, S. Deladi, F. Suijver, M. Barley, A. van Dusschoten, S. Fokkenrood, F. Zuo, F. Sacher, M. Hocini, M. Haïssaguerre, and P. Jaïs, “Real-time lesion assessment using a novel combined ultrasound and radiofrequency ablation catheter,” Heart Rhythm the Official Journal of the Heart Rhythm Society 8(2), 304–312 (2011).

2010 (4)

G. Y. Lip, R. Nieuwlaat, R. Pisters, D. A. Lane, and H. J. Crijns, “Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation,” Chest 137(2), 263–272 (2010).
[Crossref] [PubMed]

C. P. Fleming, K. J. Quan, and A. M. Rollins, “Toward guidance of epicardial cardiac radiofrequency ablation therapy using optical coherence tomography,” J. Biomed. Opt. 15(4), 041510 (2010).
[Crossref] [PubMed]

C. P. Fleming, H. Wang, K. J. Quan, and A. M. Rollins, “Real-time monitoring of cardiac radio-frequency ablation lesion formation using an optical coherence tomography forward-imaging catheter,” J. Biomed. Opt. 15(3), 030516 (2010).
[Crossref] [PubMed]

C. P. Fleming, K. J. Quan, H. Wang, G. Amit, and A. M. Rollins, “In vitro characterization of cardiac radiofrequency ablation lesions using optical coherence tomography,” Opt. Express 18(3), 3079–3092 (2010).
[Crossref] [PubMed]

2009 (2)

P. Taroni, A. Bassi, D. Comelli, A. Farina, R. Cubeddu, and A. Pifferi, “Diffuse optical spectroscopy of breast tissue extended to 1100 nm,” J. Biomed. Opt. 14(5), 054030 (2009).
[Crossref] [PubMed]

C. M. Ambrosi, N. Moazami, A. M. Rollins, and I. R. Efimov, “Virtual histology of the human heart using optical coherence tomography,” J. Biomed. Opt. 14(5), 054002 (2009).
[Crossref] [PubMed]

2008 (4)

R. Reif, M. S. Amorosino, K. W. Calabro, O. A’Amar, S. K. Singh, and I. J. Bigio, “Analysis of changes in reflectance measurements on biological tissues subjected to different probe pressures,” J. Biomed. Opt. 13(1), 010502 (2008).
[Crossref] [PubMed]

A. d’Avila and J. N. Ruskin, “Nonpharmacologic strategies: the evolving story of ablation and hybrid therapy,” Am. J. Cardiol. 102(66A), 20H–24H (2008).
[Crossref] [PubMed]

E. Alerstam, T. Svensson, and S. Andersson-Engels, “Parallel computing with graphics processing units for high-speed Monte Carlo simulation of photon migration,” J. Biomed. Opt. 13(6), 060504 (2008).
[Crossref] [PubMed]

S. G. Demos and S. Sharareh, “Real time assessment of RF cardiac tissue ablation with optical spectroscopy,” Opt. Express 16(19), 15286–15296 (2008).
[Crossref] [PubMed]

2007 (1)

2006 (1)

2005 (2)

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
[Crossref] [PubMed]

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
[Crossref] [PubMed]

2004 (1)

A. d’Avila, C. Houghtaling, P. Gutierrez, O. Vragovic, J. N. Ruskin, M. E. Josephson, and V. Y. Reddy, “Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy,” Circulation 109(19), 2363–2369 (2004).
[Crossref] [PubMed]

2003 (3)

J. Swartling, S. Pålsson, P. Platonov, S. B. Olsson, and S. Andersson-Engels, “Changes in tissue optical properties due to radio-frequency ablation of myocardium,” Med. Biol. Eng. Comput. 41(4), 403–409 (2003).
[Crossref] [PubMed]

S. P. Thomas, D. J. Guy, A. C. Boyd, V. E. Eipper, D. L. Ross, and R. B. Chard, “Comparison of epicardial and endocardial linear ablation using handheld probes,” Ann. Thorac. Surg. 75(2), 543–548 (2003).
[Crossref] [PubMed]

S. Dixit, N. Narula, D. J. Callans, and F. E. Marchlinski, “Electroanatomic mapping of human heart: epicardial fat can mimic scar,” J. Cardiovasc. Electrophysiol. 14(10), 1128 (2003).
[Crossref] [PubMed]

2002 (1)

H. Oral, B. P. Knight, M. Ozaydin, H. Tada, A. Chugh, S. Hassan, C. Scharf, S. W. Lai, R. Greenstein, F. Pelosi, S. A. Strickberger, and F. Morady, “Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation,” J. Am. Coll. Cardiol. 40(1), 100–104 (2002).
[Crossref] [PubMed]

1999 (1)

H. Høgh Petersen, X. Chen, A. Pietersen, J. H. Svendsen, and S. Haunsø, “Lesion dimensions during temperature-controlled radiofrequency catheter ablation of left ventricular porcine myocardium: impact of ablation site, electrode size, and convective cooling,” Circulation 99(2), 319–325 (1999).
[Crossref] [PubMed]

1998 (1)

D. L. Dries, D. V. Exner, B. J. Gersh, M. J. Domanski, M. A. Waclawiw, and L. W. Stevenson, “Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction,” J. Am. Coll. Cardiol. 32(3), 695–703 (1998).
[Crossref] [PubMed]

1997 (1)

1996 (1)

R. Agah, A. H. Gandjbakhche, M. Motamedi, R. Nossal, and R. F. Bonner, “Dynamics of temperature dependent optical properties of tissue: dependence on thermally induced alteration,” IEEE Trans. Biomed. Eng. 43(8), 839–846 (1996).
[Crossref] [PubMed]

1993 (3)

1991 (1)

1990 (2)

S. L. J. Thomsen and S. L. Flock, S. T. “Microscopic correlates of macroscopic optical property changes during thermal coagulation of myocardium,” Proc. Soc. Photo Opt. Instrum. Eng. 1202, 2–10 (1990).

G. J. Derbyshire, D. K. Bogen, and M. Unger, “Thermally induced optical property changes in myocardium at 1.06 μm,” Lasers Surg. Med. 10(1), 28–34 (1990).
[Crossref] [PubMed]

1987 (1)

M. C. Schaub and H. O. Hirzel, “Atrial and ventricular isomyosin composition in patients with different forms of cardiac hypertrophy,” Basic Res. Cardiol. 82(Suppl 2), 357–367 (1987).
[PubMed]

1983 (1)

J. S. Charnock, W. F. Dryden, E. J. McMurchie, M. Y. Abeywardena, and G. R. Russell, “Differences in the fatty acid composition of atrial and ventricular phospholipids of rat heart following standard and lipid-supplemented diets,” Comp. Biochem. Physiol. B 75(1), 47–52 (1983).
[Crossref] [PubMed]

1973 (1)

M. J. Legato, “Ultrastructure of the atrial, ventricular, and Purkinje cell, with special reference to the genesis of arrhythmias,” Circulation 47(1), 178–189 (1973).
[Crossref] [PubMed]

1949 (1)

W. J. Bowen, “The absorption spectra and extinction coefficients of myoglobin,” J. Biol. Chem. 179(1), 235–245 (1949).
[PubMed]

A’Amar, O.

R. Reif, M. S. Amorosino, K. W. Calabro, O. A’Amar, S. K. Singh, and I. J. Bigio, “Analysis of changes in reflectance measurements on biological tissues subjected to different probe pressures,” J. Biomed. Opt. 13(1), 010502 (2008).
[Crossref] [PubMed]

R. Reif, O. A’Amar, and I. J. Bigio, “Analytical model of light reflectance for extraction of the optical properties in small volumes of turbid media,” Appl. Opt. 46(29), 7317–7328 (2007).
[Crossref] [PubMed]

Abbara, S.

R. Beinart, S. Abbara, A. Blum, M. Ferencik, K. Heist, J. Ruskin, and M. Mansour, “Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation,” J. Cardiovasc. Electrophysiol. 22(11), 1232–1236 (2011).
[Crossref] [PubMed]

Abeywardena, M. Y.

J. S. Charnock, W. F. Dryden, E. J. McMurchie, M. Y. Abeywardena, and G. R. Russell, “Differences in the fatty acid composition of atrial and ventricular phospholipids of rat heart following standard and lipid-supplemented diets,” Comp. Biochem. Physiol. B 75(1), 47–52 (1983).
[Crossref] [PubMed]

Agah, R.

R. Agah, A. H. Gandjbakhche, M. Motamedi, R. Nossal, and R. F. Bonner, “Dynamics of temperature dependent optical properties of tissue: dependence on thermally induced alteration,” IEEE Trans. Biomed. Eng. 43(8), 839–846 (1996).
[Crossref] [PubMed]

Alerstam, E.

E. Alerstam, T. Svensson, and S. Andersson-Engels, “Parallel computing with graphics processing units for high-speed Monte Carlo simulation of photon migration,” J. Biomed. Opt. 13(6), 060504 (2008).
[Crossref] [PubMed]

Ambrosi, C. M.

C. M. Ambrosi, N. Moazami, A. M. Rollins, and I. R. Efimov, “Virtual histology of the human heart using optical coherence tomography,” J. Biomed. Opt. 14(5), 054002 (2009).
[Crossref] [PubMed]

Amit, G.

Amorosino, M. S.

R. Reif, M. S. Amorosino, K. W. Calabro, O. A’Amar, S. K. Singh, and I. J. Bigio, “Analysis of changes in reflectance measurements on biological tissues subjected to different probe pressures,” J. Biomed. Opt. 13(1), 010502 (2008).
[Crossref] [PubMed]

Andersson-Engels, S.

E. Alerstam, T. Svensson, and S. Andersson-Engels, “Parallel computing with graphics processing units for high-speed Monte Carlo simulation of photon migration,” J. Biomed. Opt. 13(6), 060504 (2008).
[Crossref] [PubMed]

J. Swartling, S. Pålsson, P. Platonov, S. B. Olsson, and S. Andersson-Engels, “Changes in tissue optical properties due to radio-frequency ablation of myocardium,” Med. Biol. Eng. Comput. 41(4), 403–409 (2003).
[Crossref] [PubMed]

Antz, M.

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
[Crossref] [PubMed]

Arruda, M.

C. P. Fleming, N. Rosenthal, A. M. Rollins, and M. Arruda, “First in vivo real-time imaging of endocardial radiofrequency ablation by optical coherence tomography: implications on safety and the birth of “electro-structural” substrate-guided ablation,” The Journal of Innovations in Cardiac Rhythm Management 2,199–201 (2011).

H. Wang, W. Kang, T. Carrigan, A. Bishop, N. Rosenthal, M. Arruda, and A. M. Rollins, “In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation,” J. Biomed. Opt. 16(11), 110505 (2011).
[Crossref] [PubMed]

Asfour, H.

M. Mercader, L. Swift, S. Sood, H. Asfour, M. Kay, and N. Sarvazyan, “Use of endogenous NADH fluorescence for real-time in situ visualization of epicardial radiofrequency ablation lesions and gaps,” Am. J. Physiol. Heart Circ. Physiol. 302(10), H2131–H2138 (2012).
[Crossref] [PubMed]

Bänsch, D.

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
[Crossref] [PubMed]

Barley, M.

M. Wright, E. Harks, S. Deladi, F. Suijver, M. Barley, A. van Dusschoten, S. Fokkenrood, F. Zuo, F. Sacher, M. Hocini, M. Haïssaguerre, and P. Jaïs, “Real-time lesion assessment using a novel combined ultrasound and radiofrequency ablation catheter,” Heart Rhythm the Official Journal of the Heart Rhythm Society 8(2), 304–312 (2011).

Bash, D.

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
[Crossref] [PubMed]

Bassi, A.

P. Taroni, A. Bassi, D. Comelli, A. Farina, R. Cubeddu, and A. Pifferi, “Diffuse optical spectroscopy of breast tissue extended to 1100 nm,” J. Biomed. Opt. 14(5), 054030 (2009).
[Crossref] [PubMed]

Beek, J. F.

Beinart, R.

S. Nazarian and R. Beinart, “CMR-guided targeting of gaps after initial pulmonary vein isolation,” JACC Cardiovasc. Imaging 7(7), 664–666 (2014).
[Crossref] [PubMed]

R. Beinart, S. Abbara, A. Blum, M. Ferencik, K. Heist, J. Ruskin, and M. Mansour, “Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation,” J. Cardiovasc. Electrophysiol. 22(11), 1232–1236 (2011).
[Crossref] [PubMed]

Benjamin, E. J.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
[Crossref] [PubMed]

Berry, J. D.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
[Crossref] [PubMed]

Bhargava, M.

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
[Crossref] [PubMed]

Bigio, I. J.

R. P. Singh-Moon, D. M. Roblyer, I. J. Bigio, and S. Joshi, “Spatial mapping of drug delivery to brain tissue using hyperspectral spatial frequency-domain imaging,” J. Biomed. Opt. 19(9), 096003 (2014).
[Crossref] [PubMed]

R. Reif, M. S. Amorosino, K. W. Calabro, O. A’Amar, S. K. Singh, and I. J. Bigio, “Analysis of changes in reflectance measurements on biological tissues subjected to different probe pressures,” J. Biomed. Opt. 13(1), 010502 (2008).
[Crossref] [PubMed]

R. Reif, O. A’Amar, and I. J. Bigio, “Analytical model of light reflectance for extraction of the optical properties in small volumes of turbid media,” Appl. Opt. 46(29), 7317–7328 (2007).
[Crossref] [PubMed]

J. R. Mourant, T. Fuselier, J. Boyer, T. M. Johnson, and I. J. Bigio, “Predictions and measurements of scattering and absorption over broad wavelength ranges in tissue phantoms,” Appl. Opt. 36(4), 949–957 (1997).
[Crossref] [PubMed]

Bishop, A.

H. Wang, W. Kang, T. Carrigan, A. Bishop, N. Rosenthal, M. Arruda, and A. M. Rollins, “In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation,” J. Biomed. Opt. 16(11), 110505 (2011).
[Crossref] [PubMed]

Blaha, M. J.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
[Crossref] [PubMed]

Blokland, P.

Blum, A.

R. Beinart, S. Abbara, A. Blum, M. Ferencik, K. Heist, J. Ruskin, and M. Mansour, “Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation,” J. Cardiovasc. Electrophysiol. 22(11), 1232–1236 (2011).
[Crossref] [PubMed]

Bogen, D. K.

G. J. Derbyshire, D. K. Bogen, and M. Unger, “Thermally induced optical property changes in myocardium at 1.06 μm,” Lasers Surg. Med. 10(1), 28–34 (1990).
[Crossref] [PubMed]

Bonner, R. F.

R. Agah, A. H. Gandjbakhche, M. Motamedi, R. Nossal, and R. F. Bonner, “Dynamics of temperature dependent optical properties of tissue: dependence on thermally induced alteration,” IEEE Trans. Biomed. Eng. 43(8), 839–846 (1996).
[Crossref] [PubMed]

Bonso, A.

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
[Crossref] [PubMed]

Bosman, S.

Bowen, W. J.

W. J. Bowen, “The absorption spectra and extinction coefficients of myoglobin,” J. Biol. Chem. 179(1), 235–245 (1949).
[PubMed]

Boyd, A. C.

S. P. Thomas, D. J. Guy, A. C. Boyd, V. E. Eipper, D. L. Ross, and R. B. Chard, “Comparison of epicardial and endocardial linear ablation using handheld probes,” Ann. Thorac. Surg. 75(2), 543–548 (2003).
[Crossref] [PubMed]

Boyer, J.

Brachmann, J.

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
[Crossref] [PubMed]

Cabrera, J. A.

D. Sánchez-Quintana, J. R. López-Mínguez, Y. Macías, J. A. Cabrera, and F. Saremi, “Left atrial anatomy relevant to catheter ablation,” Cardiol. Res. Pract. 2014, 289720 (2014).
[Crossref] [PubMed]

Calabro, K. W.

R. Reif, M. S. Amorosino, K. W. Calabro, O. A’Amar, S. K. Singh, and I. J. Bigio, “Analysis of changes in reflectance measurements on biological tissues subjected to different probe pressures,” J. Biomed. Opt. 13(1), 010502 (2008).
[Crossref] [PubMed]

Calkins, H.

J. Dewire and H. Calkins, “Update on atrial fibrillation catheter ablation technologies and techniques,” Nat. Rev. Cardiol. 10(10), 599–612 (2013).
[Crossref] [PubMed]

H. Calkins, R. el-Atassi, S. J. Kalbfleisch, J. J. Langberg, and F. Morady, “Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways,” Am. J. Cardiol. 71(12), 1104–1105 (1993).
[Crossref] [PubMed]

Callans, D. J.

S. Dixit, N. Narula, D. J. Callans, and F. E. Marchlinski, “Electroanatomic mapping of human heart: epicardial fat can mimic scar,” J. Cardiovasc. Electrophysiol. 14(10), 1128 (2003).
[Crossref] [PubMed]

Carrigan, T.

H. Wang, W. Kang, T. Carrigan, A. Bishop, N. Rosenthal, M. Arruda, and A. M. Rollins, “In vivo intracardiac optical coherence tomography imaging through percutaneous access: toward image-guided radio-frequency ablation,” J. Biomed. Opt. 16(11), 110505 (2011).
[Crossref] [PubMed]

Chard, R. B.

S. P. Thomas, D. J. Guy, A. C. Boyd, V. E. Eipper, D. L. Ross, and R. B. Chard, “Comparison of epicardial and endocardial linear ablation using handheld probes,” Ann. Thorac. Surg. 75(2), 543–548 (2003).
[Crossref] [PubMed]

Charnock, J. S.

J. S. Charnock, W. F. Dryden, E. J. McMurchie, M. Y. Abeywardena, and G. R. Russell, “Differences in the fatty acid composition of atrial and ventricular phospholipids of rat heart following standard and lipid-supplemented diets,” Comp. Biochem. Physiol. B 75(1), 47–52 (1983).
[Crossref] [PubMed]

Chen, X.

H. Høgh Petersen, X. Chen, A. Pietersen, J. H. Svendsen, and S. Haunsø, “Lesion dimensions during temperature-controlled radiofrequency catheter ablation of left ventricular porcine myocardium: impact of ablation site, electrode size, and convective cooling,” Circulation 99(2), 319–325 (1999).
[Crossref] [PubMed]

Chugh, A.

H. Oral, B. P. Knight, M. Ozaydin, H. Tada, A. Chugh, S. Hassan, C. Scharf, S. W. Lai, R. Greenstein, F. Pelosi, S. A. Strickberger, and F. Morady, “Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation,” J. Am. Coll. Cardiol. 40(1), 100–104 (2002).
[Crossref] [PubMed]

Chun, J.

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
[Crossref] [PubMed]

Comelli, D.

P. Taroni, A. Bassi, D. Comelli, A. Farina, R. Cubeddu, and A. Pifferi, “Diffuse optical spectroscopy of breast tissue extended to 1100 nm,” J. Biomed. Opt. 14(5), 054030 (2009).
[Crossref] [PubMed]

Cosman, E. R.

E. R. Cosman, J. R. Dolensky, and R. A. Hoffman, “Factors that affect radiofrequency heat lesion size,” Pain Med. 15(12), 2020–2036 (2014).
[Crossref] [PubMed]

Crijns, H. J.

G. Y. Lip, R. Nieuwlaat, R. Pisters, D. A. Lane, and H. J. Crijns, “Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation,” Chest 137(2), 263–272 (2010).
[Crossref] [PubMed]

Cubeddu, R.

P. Taroni, A. Bassi, D. Comelli, A. Farina, R. Cubeddu, and A. Pifferi, “Diffuse optical spectroscopy of breast tissue extended to 1100 nm,” J. Biomed. Opt. 14(5), 054030 (2009).
[Crossref] [PubMed]

d’Avila, A.

A. d’Avila and J. N. Ruskin, “Nonpharmacologic strategies: the evolving story of ablation and hybrid therapy,” Am. J. Cardiol. 102(66A), 20H–24H (2008).
[Crossref] [PubMed]

A. d’Avila, C. Houghtaling, P. Gutierrez, O. Vragovic, J. N. Ruskin, M. E. Josephson, and V. Y. Reddy, “Catheter ablation of ventricular epicardial tissue: a comparison of standard and cooled-tip radiofrequency energy,” Circulation 109(19), 2363–2369 (2004).
[Crossref] [PubMed]

Dai, S.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
[Crossref] [PubMed]

Deger, F. T.

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
[Crossref] [PubMed]

Deladi, S.

M. Wright, E. Harks, S. Deladi, F. Suijver, M. Barley, A. van Dusschoten, S. Fokkenrood, F. Zuo, F. Sacher, M. Hocini, M. Haïssaguerre, and P. Jaïs, “Real-time lesion assessment using a novel combined ultrasound and radiofrequency ablation catheter,” Heart Rhythm the Official Journal of the Heart Rhythm Society 8(2), 304–312 (2011).

Demos, S. G.

Derbyshire, G. J.

G. J. Derbyshire, D. K. Bogen, and M. Unger, “Thermally induced optical property changes in myocardium at 1.06 μm,” Lasers Surg. Med. 10(1), 28–34 (1990).
[Crossref] [PubMed]

Dewire, J.

J. Dewire and H. Calkins, “Update on atrial fibrillation catheter ablation technologies and techniques,” Nat. Rev. Cardiol. 10(10), 599–612 (2013).
[Crossref] [PubMed]

Dixit, S.

S. Dixit, N. Narula, D. J. Callans, and F. E. Marchlinski, “Electroanatomic mapping of human heart: epicardial fat can mimic scar,” J. Cardiovasc. Electrophysiol. 14(10), 1128 (2003).
[Crossref] [PubMed]

Dolensky, J. R.

E. R. Cosman, J. R. Dolensky, and R. A. Hoffman, “Factors that affect radiofrequency heat lesion size,” Pain Med. 15(12), 2020–2036 (2014).
[Crossref] [PubMed]

Domanski, M. J.

D. L. Dries, D. V. Exner, B. J. Gersh, M. J. Domanski, M. A. Waclawiw, and L. W. Stevenson, “Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction,” J. Am. Coll. Cardiol. 32(3), 695–703 (1998).
[Crossref] [PubMed]

Dries, D. L.

D. L. Dries, D. V. Exner, B. J. Gersh, M. J. Domanski, M. A. Waclawiw, and L. W. Stevenson, “Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction,” J. Am. Coll. Cardiol. 32(3), 695–703 (1998).
[Crossref] [PubMed]

Dryden, W. F.

J. S. Charnock, W. F. Dryden, E. J. McMurchie, M. Y. Abeywardena, and G. R. Russell, “Differences in the fatty acid composition of atrial and ventricular phospholipids of rat heart following standard and lipid-supplemented diets,” Comp. Biochem. Physiol. B 75(1), 47–52 (1983).
[Crossref] [PubMed]

Efimov, I. R.

C. M. Ambrosi, N. Moazami, A. M. Rollins, and I. R. Efimov, “Virtual histology of the human heart using optical coherence tomography,” J. Biomed. Opt. 14(5), 054002 (2009).
[Crossref] [PubMed]

Eipper, V. E.

S. P. Thomas, D. J. Guy, A. C. Boyd, V. E. Eipper, D. L. Ross, and R. B. Chard, “Comparison of epicardial and endocardial linear ablation using handheld probes,” Ann. Thorac. Surg. 75(2), 543–548 (2003).
[Crossref] [PubMed]

el-Atassi, R.

H. Calkins, R. el-Atassi, S. J. Kalbfleisch, J. J. Langberg, and F. Morady, “Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways,” Am. J. Cardiol. 71(12), 1104–1105 (1993).
[Crossref] [PubMed]

Ernst, S.

F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
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Exner, D. V.

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A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Kittner, S. J.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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F. Ouyang, M. Antz, S. Ernst, H. Hachiya, H. Mavrakis, F. T. Deger, A. Schaumann, J. Chun, P. Falk, D. Hennig, X. Liu, D. Bänsch, and K. H. Kuck, “Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique,” Circulation 111(2), 127–135 (2005).
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Lackland, D. T.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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H. Oral, B. P. Knight, M. Ozaydin, H. Tada, A. Chugh, S. Hassan, C. Scharf, S. W. Lai, R. Greenstein, F. Pelosi, S. A. Strickberger, and F. Morady, “Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation,” J. Am. Coll. Cardiol. 40(1), 100–104 (2002).
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H. Calkins, R. el-Atassi, S. J. Kalbfleisch, J. J. Langberg, and F. Morady, “Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways,” Am. J. Cardiol. 71(12), 1104–1105 (1993).
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A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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G. Y. Lip, R. Nieuwlaat, R. Pisters, D. A. Lane, and H. J. Crijns, “Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation,” Chest 137(2), 263–272 (2010).
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A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Macías, Y.

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Mackey, R. H.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Magid, D. J.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Mansour, M.

R. Beinart, S. Abbara, A. Blum, M. Ferencik, K. Heist, J. Ruskin, and M. Mansour, “Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation,” J. Cardiovasc. Electrophysiol. 22(11), 1232–1236 (2011).
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Marchlinski, F. E.

S. Dixit, N. Narula, D. J. Callans, and F. E. Marchlinski, “Electroanatomic mapping of human heart: epicardial fat can mimic scar,” J. Cardiovasc. Electrophysiol. 14(10), 1128 (2003).
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Marcus, G. M.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Marelli, A.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Mavrakis, H.

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A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Mohler, E. R.

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Morady, F.

H. Oral, B. P. Knight, M. Ozaydin, H. Tada, A. Chugh, S. Hassan, C. Scharf, S. W. Lai, R. Greenstein, F. Pelosi, S. A. Strickberger, and F. Morady, “Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation,” J. Am. Coll. Cardiol. 40(1), 100–104 (2002).
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H. Calkins, R. el-Atassi, S. J. Kalbfleisch, J. J. Langberg, and F. Morady, “Effect of operator experience on outcome of radiofrequency catheter ablation of accessory pathways,” Am. J. Cardiol. 71(12), 1104–1105 (1993).
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R. Agah, A. H. Gandjbakhche, M. Motamedi, R. Nossal, and R. F. Bonner, “Dynamics of temperature dependent optical properties of tissue: dependence on thermally induced alteration,” IEEE Trans. Biomed. Eng. 43(8), 839–846 (1996).
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Moy, C. S.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Mozaffarian, D.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Mussolino, M. E.

A. S. Go, D. Mozaffarian, V. L. Roger, E. J. Benjamin, J. D. Berry, M. J. Blaha, S. Dai, E. S. Ford, C. S. Fox, S. Franco, H. J. Fullerton, C. Gillespie, S. M. Hailpern, J. A. Heit, V. J. Howard, M. D. Huffman, S. E. Judd, B. M. Kissela, S. J. Kittner, D. T. Lackland, J. H. Lichtman, L. D. Lisabeth, R. H. Mackey, D. J. Magid, G. M. Marcus, A. Marelli, D. B. Matchar, D. K. McGuire, E. R. Mohler, C. S. Moy, M. E. Mussolino, R. W. Neumar, G. Nichol, D. K. Pandey, N. P. Paynter, M. J. Reeves, P. D. Sorlie, J. Stein, A. Towfighi, T. N. Turan, S. S. Virani, N. D. Wong, D. Woo, M. B. Turner, and American Heart Association Statistics Committee and Stroke Statistics Subcommittee, “Heart disease and stroke statistics–2014 update: a report from the American Heart Association,” Circulation 129(3), e28–e292 (2014).
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Narula, N.

S. Dixit, N. Narula, D. J. Callans, and F. E. Marchlinski, “Electroanatomic mapping of human heart: epicardial fat can mimic scar,” J. Cardiovasc. Electrophysiol. 14(10), 1128 (2003).
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Natale, A.

O. M. Wazni, N. F. Marrouche, D. O. Martin, A. Verma, M. Bhargava, W. Saliba, D. Bash, R. Schweikert, J. Brachmann, J. Gunther, K. Gutleben, E. Pisano, D. Potenza, R. Fanelli, A. Raviele, S. Themistoclakis, A. Rossillo, A. Bonso, and A. Natale, “Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial,” JAMA 293(21), 2634–2640 (2005).
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H. Høgh Petersen, X. Chen, A. Pietersen, J. H. Svendsen, and S. Haunsø, “Lesion dimensions during temperature-controlled radiofrequency catheter ablation of left ventricular porcine myocardium: impact of ablation site, electrode size, and convective cooling,” Circulation 99(2), 319–325 (1999).
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H. W. Tan, X. H. Wang, H. F. Shi, L. Zhou, J. N. Gu, and X. Liu, “Left atrial wall thickness: anatomic aspects relevant to catheter ablation of atrial fibrillation,” Chin. Med. J. (Engl.) 125(1), 12–15 (2012).
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Figures (9)

Fig. 1
Fig. 1 System schematic diagram and simplified ablation targets in atrial anatomy. a) shows the system layout for our NIRS-integrated RFA Catheter. The fiber optic enclosure enables a fixed separation between illumination and collection fibers necessary to employ optical property quantification methods. b) shows a typical ablation procedure. The catheter enters the right atrium (RA) through the inferior vena cava and accesses the left atrium (LA) through a transeptal puncture. Lesions are created on the endocardial surface. RV – Right ventricle; LV – Left ventricle.

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Fig. 2
Fig. 2 Chromophores used in the fitting routine to approximate near-infrared absorption spectra in cardiac tissues. All spectra were obtained from previously published literature. Water (H2O)a; oxyhemoglobin (HbO2)a; deoxyhemoglobin (Hb)a; lipidb; reduced oxymyoglobin (Mb)b; met-myoglobin (met-Mb)b; oxymyoglobin (MbO2)b; and collagenc; a-Obtained from Jacques et al.; b-Obtained from Bowen et. al.; c-Obtained from Taroni et. al.

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Fig. 3
Fig. 3 MC Simulated Characteristics of the NIRS-Integrated catheter. A) shows the effect of measured reflectance (RRel) due to changes in tissue optical properties as derived from MC simulations. RRel exhibited exponential decay as a function of increasing µa. RRel increases gradually for small µs’, then decreases monotonically after reaching an infection point at before 10 cm−1. B) shows the MVD distribution (black curve) for 10,000 collected photons simulated for normal myocardium tissue. The distribution was fit to a log-normal function (red curve) to approximate the mean MVD of the collected photons.

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Fig. 4
Fig. 4 Validation of model extraction for absorption and scattering coefficient. Results from absorption (μa) and reduced scattering (μs’) variation study in experimental tissue phantoms. A) For absorption variation experiments, measurements of were taken from eight concentrations of Evans Blue dye (EB) in 1% Intralipid. The absorption coefficient was extracted using the proposed inversion algorithm. B) For scattering variation experiments, serial dilutions of Intralipid were measured at four volume fractions with no added absorber and reduced scattering coefficients were determined by our the algorithm. All optical properties are presented at 620 nm.

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Fig. 5
Fig. 5 Representative histological correlates of RF treated human atrial samples along with respective optical measurements. Panels (a) and (b) shows Masson’s Trichrome staining and corresponding measured tissue reflectance, absorption, and reduced scattering for normal LA and RA specimens, respectively. (c),(d) and (e),(f) shows similar LA and RA measurements obtained for superficial and transmural lesions, respectively. Collagen is represented by blue appearance, while red denotes the intact myocardium. Areas of tissue necrosis are identified with arrows and manifest as a purple hue in the trichrome stained slide. Spectral changes are clearly identified with respect to degree of RFA treatment. Specifically, progressive lesion transmurality is seen to be consistent with decreased tissue reflectance and increased absorption and reduced scattering. RA - right atrium, LA – left atrium; Bar is 2mm.

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Fig. 6
Fig. 6 Statistical analysis of determined chromophore concentrations for ex vivo human atrial samples. All parameters were extracted simultaneously for each sample in the each of the four cohorts. The number of samples for each group was as follows: untreated LA (n = 34), untreated RA (n = 30), treated LA (n = 13), treated RA (n = 11). Bars are presented as mean and standard deviation.. Statistical significance with respect to LA_abl group: °(p<0.05), °°(p<0.001), °°°(p<0.0001); Statistical significance with respect to RA_abl group: *(p<0.05), **(p<0.001), ***(p<0.0001).

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Fig. 7
Fig. 7 Representative gross pathology and spectra taken from ex vivo swine cardiac tissues. Panel (a) shows from left to right a TTC stained, gross pathology cross-section of the normal myocardium and corresponding tissue reflectance, absorption, and reduced scattering measurements. Red denotes the uninjured, intact myocardium. (b) and (c) shows similar measurements obtained for superficial and deep lesions, respectively. The pale areas marked by the arrows denote the regions of tissue necrosis. It is observed that regions of increased lesion depth were also consistent also associated with decreased tissue reflectance and increased absorption and reduced scattering in swine cardiac tissue. Bar is 3mm.

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Fig. 8
Fig. 8 Lesion Gap Assessment in Swine Atria. (a) shows two representative right atrial samples of measurements taken along a discontinuous lesion segment. From top to bottom shows a cross-section of TTC stained RA tissue after a discontinuous line RFA treatment, extracted lesion depth from image processing, inverted RRel, and extracted μa as a function of lateral distance. Bar is 3 mm. (b) shows a correlation of the inverted RRel parameter and absorption with lesion depth. Black dashed lines indicates the 95% confidence interval band. All optical properties are expressed at 730 nm and were determined from the mean of 12 spectra.

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Fig. 9
Fig. 9 Verification of tissue-catheter contact in the presence of blood. An exemplary example of spectra acquired in contact and 2mm above the tissue surface. Measurements were made on excised swine heart tissue submerge in whole blood to assess changes in reflectance seen with catheter contact. The grey line shows a measurement taken with the catheter 2 mm above the tissue, not in contact. A large signal increase is seen when the catheter is in contact with the tissue (black line). Mean +/− standard deviation.

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Equations (3)

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R R e l ( λ ) = I t i s s u e ( λ ) I s p e c t r a l o n ( λ ) × I s p e c t r a l o n ( λ 0 ) I c a l ( λ 0 ) .
μ a ( λ ) = B ( S μ a , H b O ( λ ) + ( 1 − S ) μ a , H b ( λ ) ) + W μ a , H 2 O ( λ ) + F μ a , l i p i d ( λ ) + C μ a , c o l l ( λ ) + 2.3 [ c M b O ⋅ ε M b O ( λ ) + c M b ⋅ ε M b ( λ ) + c M m b ⋅ ε M m b ( λ ) ]
μ s ' ( λ ) = a ( λ 730 n m ) − b .

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