In vitro characterization of cardiac radiofrequency ablation lesions using optical coherence tomography

Christine P. Fleming; Kara J. Quan; Hui Wang; Guy Amit; Andrew M. Rollins

doi:10.1364/OE.18.003079

In vitro characterization of cardiac radiofrequency ablation lesions using optical coherence tomography

Christine P. Fleming, Kara J. Quan, Hui Wang, Guy Amit, and Andrew M. Rollins

Optics Express
Vol. 18,
Issue 3,
pp. 3079-3092
(2010)
•https://doi.org/10.1364/OE.18.003079

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Christine P. Fleming, Kara J. Quan, Hui Wang, Guy Amit, and Andrew M. Rollins, "In vitro characterization of cardiac radiofrequency ablation lesions using optical coherence tomography," Opt. Express 18, 3079-3092 (2010)

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Related Topics
Table of Contents Category
- Medical Optics and Biotechnology
Optics & Photonics Topics
?

The topics in this list come from the OSA Optics and Photonics Topics applied to this article.
Previously assigned OCIS codes
- Ablation of tissue (170.1020)
- Clinical applications (170.1610)
- Optical coherence tomography (170.4500)
- Tissue characterization (170.6935)

About this Article
History
- Original Manuscript: September 28, 2009
- Revised Manuscript: December 21, 2009
- Manuscript Accepted: December 22, 2009
- Published: January 28, 2010
Virtual Issues
Virtual Journal for Biomedical Optics Vol. 5, Iss. 4

Accessible

Open Access

Abstract

Currently, cardiac radiofrequency ablation (RFA) is guided by indirect signals. We demonstrate optical coherence tomography (OCT) characterization of RFA lesions within swine ventricular wedges. Untreated tissue exhibited a consistent birefringence artifact within OCT images due to the organized myocardium, which was not present in treated tissue. Birefringence artifacts were detected by filtering with a Laplacian of Gaussian (LoG) to quantify gradient strength. The gradient strength distinguished RFA lesions from untreated sites (p=5.93×10^-15) with a sensitivity and specificity of 94.5% and 86.7% respectively. This study demonstrates the potential of OCT for monitoring cardiac RFA, confirming lesion formation and providing feedback to avoid complications.

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References

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Publication

W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, S. Kittner, D. Lloyd-Jones, M. McDermott, J. Meigs, C. Moy, G. Nicho, C. O’Donnell, V. Roger, P. Sorlie, J. Steinberger, T. Thom, M. Wilson, and Y. Hong, “Heart Disease and Stroke Statistics 2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee,” Circulation 117, e25–e146 (2008).
[Crossref]
S. K. S. Huang and M. A. Wood, Catheter Ablation of Cardiac Arrhythmias (Saunders, 2006).
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B. Joung, M. Lee, J.-H. Sung, J.-Y. Kim, S. Ahn, and S. Kim, “Pediatric Radiofrequency Catheter Ablation Sedation Methods and Success, Complication and Recurrence Rates,” Circulation Journal 70, 278–284 (2006).
[Crossref] [PubMed]
A. O. Grant, “Recent Advances in the Treatment of Arrhythmias,” Circulation Journal 67, 651–655 (2003).
[Crossref] [PubMed]
D. O’Donnell and V. Nadurata, “Radiofrequency Ablation for Post Infarction Ventricular Tachycardia,” Indian Pacing Electrophysiol. J. 4, 63–72 (2004).
T. Dickfeld, R. Kato, M. Zviman, S. Nazarian, H. Ashikaga, A. C. Lardo, R. D. Berger, H. Calkins, and H. Halperin, “Characterization of Acute and Subacute Radiofrequency Ablation Lesions with Non-enhanced Magnetic Resonance Imaging,” Heart Rhythm 4, 208–214 (2007).
[Crossref] [PubMed]
T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, and H. Halperin, “Characterization of Radiofrequency Ablation Lesions with Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging,” J Am Coll Cardiol 47, 370–378 (2006).
[Crossref] [PubMed]
J. Alaeddini, M. A. Wood, B. P. Lee, and K. A. Ellenbogen, “Incidence, Time Course, and Characteristics of Microbubble Formation During Radiofrequency Ablation of Pulmonary Veins with an 8-mm Ablation Catheter,” Pacing Clin Electrophysiol 29, 979–984 (2006).
[Crossref] [PubMed]
M. David Schwartzman, R. John Nosbisch, and R. Debra Housel, “Echocardiographically guided left atrial ablation: Characterization of a new technique,” Heart Rhythm Society 3, 930–938 (2006).
[Crossref]
T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, and H. Halperin, “erization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging,” Journal of the American College of Cardiology 47, 370–378 (2008).
[Crossref]
T. Dickfeld, R. Kato, M. Zviman, S. Nazarian, J. Dong, H. Ashikaga, A. C. Lardo, R. D. Berger, H. Calkins, and H. Halperin, “Characterization of acute and subacute radiofrequency ablation lesions with nonenhanced magnetic resonance imaging,” Heart Rhythm 4, 208–214 (2007).
[Crossref] [PubMed]
E. J. Schmidt, V. K. Reddy, and J. N. Ruskin, “Nonenhanced magnetic resonance imaging for characterization of acute and subacute radiofrequency ablation lesions,” Heart Rhythm 4, 215–217 (2007).
[Crossref] [PubMed]
J.-F. Ren and F. E. Marchinski, “Utility of Intracardiac Echocardiography in Left Heart Ablation for Tachyarrhythmias,” Echocardiography 24, 533–540 (2007).
[Crossref] [PubMed]
W. Drexler and J. G. Fujimoto, eds., Optical Coherence Tomography: Technology and Applications (Springer, 2008).
[Crossref]
M. Gupta, A. M. Rollins, J. A. Izatt, and I. R. Efimov, “Imaging of the atrioventricular node using optical coherence tomography,” J Cardiovasc Electrophysiol 13, 95 (2002).
[Crossref] [PubMed]
M. W. Jenkins, R. S. Wade, Y. Cheng, A. M. Rollins, and I. R. Efimov, “Optical Coherence Tomography Imaging of the Purkinje Network,” J Cardiovasc Electrophysiol (2005).
[Crossref] [PubMed]
M. E. Brezinski, “Applications of optical coherence tomography to cardiac and musculoskeletal diseases: bench to bedside?,” J Biomed Opt 12, 051705 (2007).
[Crossref] [PubMed]
C. P. Fleming, C. Ripplinger, B. Webb, I. R. Efimov, and A. M. Rollins, “Quantification of Cardiac Fiber Orientation Using Optical Coherence Tomography,” J Biomed Opt 13, 030505 (2008).
[Crossref] [PubMed]
W. Hucker, C. Ripplinger, C. P. Fleming, V. Fedorov, A. M. Rollins, and I. R. Efimov, “Bimodal Biophotonic Imaging of the Structure-Function Relationship in Cardiac Tissue,” J Biomed Opt 13, 054012 (2008).
[Crossref] [PubMed]
N. A. Patel, X. Li, D. L. Stamper, J. G. Fujimoto, and M. E. Brezinski, “Guidance of aortic ablation using optical coherence tomography,” The International Journal of Cardiovascular Imaging 19, 171–178 (2003).
[Crossref] [PubMed]
S. A. Boppart, J. Herrmann, C. Pitris, D. L. Stamper, M. E. Brezinski, and J. G. Fujimoto, “High-Resolution Optical Coherence Tomography-Guided Laser Ablation of Surgical Tissue,” Journal of Surgical Research 82, 275–284 (1999).
[Crossref] [PubMed]
B. J. Vakoc, G. J. Tearney, and B. E. Bouma, “Real-time microscopic visualization of tissue response to laser thermal therapy,” Journal of Biomedical Optics Letters 12, 020501 (2007).
[Crossref]
M. Ford, Y. Zhou, H. Wang, C. X. Deng, and A. M. Rollins, “Optical coherence tomography monitoring of cardiac ablation by high-intensity focused ultrasound,” Proceedings of the SPIE 5686, 432 (2005).
[Crossref]
J. Swartling, S. Palsson, 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, 403–409 (2003).
[Crossref] [PubMed]
S. Sato, T. Shimada, M. Ishihara, T. Arai, T. Matsui, A. Kurita, M. Obara, M. Kikuchi, H. Wakisaka, and H. Ashida, “Laser Ablation Characteristics of Myocardium Tissue in the UV Spectral Region: An In-vitro Study with Porcine Myocardium Tissue,” in OSA BOSD, (1999).
S. Bosman, “Heat-induced structural alterations in myocardium in relation to changing optical properties,” Applied Optics 32, 461–463 (1993).
[Crossref] [PubMed]
J. M. Schmitt, A. Knuttel, M. Yadlowsky, and M. A. Eckhaus, “Optical-coherence tomography of a dense tissue: statistics of attenuation and backscattering,” Phys. Med. Biol. 39, 1705–1720 (1994).
[Crossref] [PubMed]
J. F. de Boer, S. M. Srinivas, A. Malekafzali, Z. Chen, and J. S. Nelson, “Imaging thermally damaged tissue by polarization sensitive optical coherence tomography,” Optics Express 3, 212–218 (1998).
[Crossref] [PubMed]
K. Schoenenberger, J. Bill, W. Colston, D. J. Maitland, L. B. D. Silva, and M. J. Everett, “Mapping of birefringence and thermal damage in tissue by use of polarization-sensitive optical coherence tomography,” Applied Optics 37, 6026–6036 (1998).
[Crossref]
B. Liu, M. Harman, S. Giattina, D. Stamper, Charles Demakis, M. Chilek, S. Raby, and M. Brezinski, “Characterizing of tissue microstructure with single-detector polarization-sensitive optical coherence tomography,” Applied Optics 45, 4464–4479 (2006).
[Crossref] [PubMed]
S. D. Giattina, B. K. Courtney, P. R. Herz, M. Harman, S. Shortkroff, D. L. Stamper, B. Liu, J. G. Fujimoto, and M. E. Brezinski, “Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT),” International Journal of Cardiology 107, 400–409 (2006).
[Crossref] [PubMed]
Y. Yang, L. Wu, Y. Feng, and R. K. Wang, “Observations of birefringence in tissues from optic-fibre-based optical coherence tomography,” Measurement Science and Technology 14, 41–46 (2003).
[Crossref]
A. M. Rollins, M. D. Kulkarni, S. Yazdanfar, R. Un-arunyawee, and J. A. Izatt, “In Vivo Video Rate Optical Coherence Tomography,” Optics Express 3, 219–229 (1998).
[Crossref] [PubMed]
Z. Hu and A. M. Rollins, “Quasi-telecentric optical design of a microscope-compatible OCT scanner,” Optics Express 13, 6407–6415 (2005).
[Crossref] [PubMed]
Z. Hu and A. Rollins, “Fourier domain optical coherence tomography with a linear-in-wavenumber spectrometer.,” Opt Lett 32, 3524–3527 (2007).
[Crossref]
B. Holmbom, U. Niislund, A. Eriksson, I. Virtancn, and L.-E. Thornell, “Comparison of triphenyltetrazolium chloride (TTC) staining versus detection of fibronectin in experimental myocardial infarction,” Histochemistry 99, 265–275 (1993).
[Crossref] [PubMed]
L. Bretzner and T. Lindeberg, “Feature Tracking with Automatic Selection of Spatial Scales,” Computer Vision and Image Understanding 71, 385–392 (1998).
[Crossref]
P. Whittaker, S.-m. Zheng, M. J. Patterson, R. A. Kloner, K. E. Daly, and R. A. Hartman, “Histologic Signatures of Thermal Injury: Applications in Transmyocardial Laser Revascularization and Radiofrequency Ablation,” Lasers in Surgery and Medicine 27, 305–318 (2000).
[Crossref] [PubMed]
J. M. Cooper, J. L. Sapp, U. Tedrow, C. P. Pellegrin, D. Robinson, L. M. Epstein, and W. G. Stevenson, “Ablation with an internally irrigated radiofrequency catheter: Learning how to avoid steam pops,” Heart Rhythm 1, 329–333 (2004).
[Crossref]

2008 (4)

T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, and H. Halperin, “erization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging,” Journal of the American College of Cardiology 47, 370–378 (2008).
[Crossref]

W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, S. Kittner, D. Lloyd-Jones, M. McDermott, J. Meigs, C. Moy, G. Nicho, C. O’Donnell, V. Roger, P. Sorlie, J. Steinberger, T. Thom, M. Wilson, and Y. Hong, “Heart Disease and Stroke Statistics 2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee,” Circulation 117, e25–e146 (2008).
[Crossref]

C. P. Fleming, C. Ripplinger, B. Webb, I. R. Efimov, and A. M. Rollins, “Quantification of Cardiac Fiber Orientation Using Optical Coherence Tomography,” J Biomed Opt 13, 030505 (2008).
[Crossref] [PubMed]

W. Hucker, C. Ripplinger, C. P. Fleming, V. Fedorov, A. M. Rollins, and I. R. Efimov, “Bimodal Biophotonic Imaging of the Structure-Function Relationship in Cardiac Tissue,” J Biomed Opt 13, 054012 (2008).
[Crossref] [PubMed]

2007 (7)

T. Dickfeld, R. Kato, M. Zviman, S. Nazarian, J. Dong, H. Ashikaga, A. C. Lardo, R. D. Berger, H. Calkins, and H. Halperin, “Characterization of acute and subacute radiofrequency ablation lesions with nonenhanced magnetic resonance imaging,” Heart Rhythm 4, 208–214 (2007).
[Crossref] [PubMed]

E. J. Schmidt, V. K. Reddy, and J. N. Ruskin, “Nonenhanced magnetic resonance imaging for characterization of acute and subacute radiofrequency ablation lesions,” Heart Rhythm 4, 215–217 (2007).
[Crossref] [PubMed]

J.-F. Ren and F. E. Marchinski, “Utility of Intracardiac Echocardiography in Left Heart Ablation for Tachyarrhythmias,” Echocardiography 24, 533–540 (2007).
[Crossref] [PubMed]

T. Dickfeld, R. Kato, M. Zviman, S. Nazarian, H. Ashikaga, A. C. Lardo, R. D. Berger, H. Calkins, and H. Halperin, “Characterization of Acute and Subacute Radiofrequency Ablation Lesions with Non-enhanced Magnetic Resonance Imaging,” Heart Rhythm 4, 208–214 (2007).
[Crossref] [PubMed]

B. J. Vakoc, G. J. Tearney, and B. E. Bouma, “Real-time microscopic visualization of tissue response to laser thermal therapy,” Journal of Biomedical Optics Letters 12, 020501 (2007).
[Crossref]

M. E. Brezinski, “Applications of optical coherence tomography to cardiac and musculoskeletal diseases: bench to bedside?,” J Biomed Opt 12, 051705 (2007).
[Crossref] [PubMed]

Z. Hu and A. Rollins, “Fourier domain optical coherence tomography with a linear-in-wavenumber spectrometer.,” Opt Lett 32, 3524–3527 (2007).
[Crossref]

2006 (6)

B. Liu, M. Harman, S. Giattina, D. Stamper, Charles Demakis, M. Chilek, S. Raby, and M. Brezinski, “Characterizing of tissue microstructure with single-detector polarization-sensitive optical coherence tomography,” Applied Optics 45, 4464–4479 (2006).
[Crossref] [PubMed]

S. D. Giattina, B. K. Courtney, P. R. Herz, M. Harman, S. Shortkroff, D. L. Stamper, B. Liu, J. G. Fujimoto, and M. E. Brezinski, “Assessment of coronary plaque collagen with polarization sensitive optical coherence tomography (PS-OCT),” International Journal of Cardiology 107, 400–409 (2006).
[Crossref] [PubMed]

T. Dickfeld, R. Kato, M. Zviman, S. Lai, G. Meininger, A. C. Lardo, A. Roguin, D. Blumke, R. Berger, H. Calkins, and H. Halperin, “Characterization of Radiofrequency Ablation Lesions with Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging,” J Am Coll Cardiol 47, 370–378 (2006).
[Crossref] [PubMed]

J. Alaeddini, M. A. Wood, B. P. Lee, and K. A. Ellenbogen, “Incidence, Time Course, and Characteristics of Microbubble Formation During Radiofrequency Ablation of Pulmonary Veins with an 8-mm Ablation Catheter,” Pacing Clin Electrophysiol 29, 979–984 (2006).
[Crossref] [PubMed]

M. David Schwartzman, R. John Nosbisch, and R. Debra Housel, “Echocardiographically guided left atrial ablation: Characterization of a new technique,” Heart Rhythm Society 3, 930–938 (2006).
[Crossref]

B. Joung, M. Lee, J.-H. Sung, J.-Y. Kim, S. Ahn, and S. Kim, “Pediatric Radiofrequency Catheter Ablation Sedation Methods and Success, Complication and Recurrence Rates,” Circulation Journal 70, 278–284 (2006).
[Crossref] [PubMed]

2005 (3)

M. W. Jenkins, R. S. Wade, Y. Cheng, A. M. Rollins, and I. R. Efimov, “Optical Coherence Tomography Imaging of the Purkinje Network,” J Cardiovasc Electrophysiol (2005).
[Crossref] [PubMed]

Z. Hu and A. M. Rollins, “Quasi-telecentric optical design of a microscope-compatible OCT scanner,” Optics Express 13, 6407–6415 (2005).
[Crossref] [PubMed]

M. Ford, Y. Zhou, H. Wang, C. X. Deng, and A. M. Rollins, “Optical coherence tomography monitoring of cardiac ablation by high-intensity focused ultrasound,” Proceedings of the SPIE 5686, 432 (2005).
[Crossref]

2004 (2)

D. O’Donnell and V. Nadurata, “Radiofrequency Ablation for Post Infarction Ventricular Tachycardia,” Indian Pacing Electrophysiol. J. 4, 63–72 (2004).

J. M. Cooper, J. L. Sapp, U. Tedrow, C. P. Pellegrin, D. Robinson, L. M. Epstein, and W. G. Stevenson, “Ablation with an internally irrigated radiofrequency catheter: Learning how to avoid steam pops,” Heart Rhythm 1, 329–333 (2004).
[Crossref]

2003 (4)

A. O. Grant, “Recent Advances in the Treatment of Arrhythmias,” Circulation Journal 67, 651–655 (2003).
[Crossref] [PubMed]

N. A. Patel, X. Li, D. L. Stamper, J. G. Fujimoto, and M. E. Brezinski, “Guidance of aortic ablation using optical coherence tomography,” The International Journal of Cardiovascular Imaging 19, 171–178 (2003).
[Crossref] [PubMed]

J. Swartling, S. Palsson, 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, 403–409 (2003).
[Crossref] [PubMed]

Y. Yang, L. Wu, Y. Feng, and R. K. Wang, “Observations of birefringence in tissues from optic-fibre-based optical coherence tomography,” Measurement Science and Technology 14, 41–46 (2003).
[Crossref]

2002 (1)

M. Gupta, A. M. Rollins, J. A. Izatt, and I. R. Efimov, “Imaging of the atrioventricular node using optical coherence tomography,” J Cardiovasc Electrophysiol 13, 95 (2002).
[Crossref] [PubMed]

2000 (1)

P. Whittaker, S.-m. Zheng, M. J. Patterson, R. A. Kloner, K. E. Daly, and R. A. Hartman, “Histologic Signatures of Thermal Injury: Applications in Transmyocardial Laser Revascularization and Radiofrequency Ablation,” Lasers in Surgery and Medicine 27, 305–318 (2000).
[Crossref] [PubMed]

1999 (1)

S. A. Boppart, J. Herrmann, C. Pitris, D. L. Stamper, M. E. Brezinski, and J. G. Fujimoto, “High-Resolution Optical Coherence Tomography-Guided Laser Ablation of Surgical Tissue,” Journal of Surgical Research 82, 275–284 (1999).
[Crossref] [PubMed]

1998 (4)

A. M. Rollins, M. D. Kulkarni, S. Yazdanfar, R. Un-arunyawee, and J. A. Izatt, “In Vivo Video Rate Optical Coherence Tomography,” Optics Express 3, 219–229 (1998).
[Crossref] [PubMed]

L. Bretzner and T. Lindeberg, “Feature Tracking with Automatic Selection of Spatial Scales,” Computer Vision and Image Understanding 71, 385–392 (1998).
[Crossref]

J. F. de Boer, S. M. Srinivas, A. Malekafzali, Z. Chen, and J. S. Nelson, “Imaging thermally damaged tissue by polarization sensitive optical coherence tomography,” Optics Express 3, 212–218 (1998).
[Crossref] [PubMed]

K. Schoenenberger, J. Bill, W. Colston, D. J. Maitland, L. B. D. Silva, and M. J. Everett, “Mapping of birefringence and thermal damage in tissue by use of polarization-sensitive optical coherence tomography,” Applied Optics 37, 6026–6036 (1998).
[Crossref]

1994 (1)

J. M. Schmitt, A. Knuttel, M. Yadlowsky, and M. A. Eckhaus, “Optical-coherence tomography of a dense tissue: statistics of attenuation and backscattering,” Phys. Med. Biol. 39, 1705–1720 (1994).
[Crossref] [PubMed]

1993 (2)

S. Bosman, “Heat-induced structural alterations in myocardium in relation to changing optical properties,” Applied Optics 32, 461–463 (1993).
[Crossref] [PubMed]

B. Holmbom, U. Niislund, A. Eriksson, I. Virtancn, and L.-E. Thornell, “Comparison of triphenyltetrazolium chloride (TTC) staining versus detection of fibronectin in experimental myocardial infarction,” Histochemistry 99, 265–275 (1993).
[Crossref] [PubMed]

Ahn, S.

Alaeddini, J.

Andersson-Engels, S.

Arai, T.

S. Sato, T. Shimada, M. Ishihara, T. Arai, T. Matsui, A. Kurita, M. Obara, M. Kikuchi, H. Wakisaka, and H. Ashida, “Laser Ablation Characteristics of Myocardium Tissue in the UV Spectral Region: An In-vitro Study with Porcine Myocardium Tissue,” in OSA BOSD, (1999).

Ashida, H.

Ashikaga, H.

Berger, R.

Berger, R. D.

Bill, J.

Blumke, D.

Boppart, S. A.

Bosman, S.

S. Bosman, “Heat-induced structural alterations in myocardium in relation to changing optical properties,” Applied Optics 32, 461–463 (1993).
[Crossref] [PubMed]

Bouma, B. E.

B. J. Vakoc, G. J. Tearney, and B. E. Bouma, “Real-time microscopic visualization of tissue response to laser thermal therapy,” Journal of Biomedical Optics Letters 12, 020501 (2007).
[Crossref]

Bretzner, L.

L. Bretzner and T. Lindeberg, “Feature Tracking with Automatic Selection of Spatial Scales,” Computer Vision and Image Understanding 71, 385–392 (1998).
[Crossref]

Brezinski, M.

Brezinski, M. E.

M. E. Brezinski, “Applications of optical coherence tomography to cardiac and musculoskeletal diseases: bench to bedside?,” J Biomed Opt 12, 051705 (2007).
[Crossref] [PubMed]

Brockman, R.

R. Brockman, “Cardiac Ablation Catheters Generic Arrhythmia Indications for Use; Guidance for Industry,” (FDA Center for Devices and Radiological Health. Cardiac Electrophysiology and Monitoring Branch Division of Cardiovascular and Respiratory Devices Office of Device Evaluation, Rockville, MD, 2002).

Calkins, H.

Chen, Z.

Cheng, Y.

M. W. Jenkins, R. S. Wade, Y. Cheng, A. M. Rollins, and I. R. Efimov, “Optical Coherence Tomography Imaging of the Purkinje Network,” J Cardiovasc Electrophysiol (2005).
[Crossref] [PubMed]

Chilek, M.

Colston, W.

Cooper, J. M.

Courtney, B. K.

Daly, K. E.

David Schwartzman, M.

de Boer, J. F.

Debra Housel, R.

Demakis, Charles

Deng, C. X.

Dickfeld, T.

Dong, J.

Eckhaus, M. A.

Efimov, I. R.

M. W. Jenkins, R. S. Wade, Y. Cheng, A. M. Rollins, and I. R. Efimov, “Optical Coherence Tomography Imaging of the Purkinje Network,” J Cardiovasc Electrophysiol (2005).
[Crossref] [PubMed]

M. Gupta, A. M. Rollins, J. A. Izatt, and I. R. Efimov, “Imaging of the atrioventricular node using optical coherence tomography,” J Cardiovasc Electrophysiol 13, 95 (2002).
[Crossref] [PubMed]

Ellenbogen, K. A.

Epstein, L. M.

Eriksson, A.

Everett, M. J.

Fedorov, V.

Feng, Y.

Flegal, K.

Fleming, C. P.

Ford, M.

Fujimoto, J. G.

Furie, K.

Giattina, S.

Giattina, S. D.

Go, A.

Grant, A. O.

A. O. Grant, “Recent Advances in the Treatment of Arrhythmias,” Circulation Journal 67, 651–655 (2003).
[Crossref] [PubMed]

Greenlund, K.

Gupta, M.

M. Gupta, A. M. Rollins, J. A. Izatt, and I. R. Efimov, “Imaging of the atrioventricular node using optical coherence tomography,” J Cardiovasc Electrophysiol 13, 95 (2002).
[Crossref] [PubMed]

Haase, N.

Hailpern, S. M.

Halperin, H.

Harman, M.

Hartman, R. A.

Herrmann, J.

Herz, P. R.

Ho, M.

Holmbom, B.

Hong, Y.

Howard, V.

Hu, Z.

Z. Hu and A. Rollins, “Fourier domain optical coherence tomography with a linear-in-wavenumber spectrometer.,” Opt Lett 32, 3524–3527 (2007).
[Crossref]

Z. Hu and A. M. Rollins, “Quasi-telecentric optical design of a microscope-compatible OCT scanner,” Optics Express 13, 6407–6415 (2005).
[Crossref] [PubMed]

Huang, S. K. S.

S. K. S. Huang and M. A. Wood, Catheter Ablation of Cardiac Arrhythmias (Saunders, 2006).

Hucker, W.

Ishihara, M.

Izatt, J. A.

M. Gupta, A. M. Rollins, J. A. Izatt, and I. R. Efimov, “Imaging of the atrioventricular node using optical coherence tomography,” J Cardiovasc Electrophysiol 13, 95 (2002).
[Crossref] [PubMed]

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Figure 1. Experimental setup for in vitro characterization of ablation lesions using OCT. A) In vitro radiofrequency ablation lesions created on excised ventricular wedges in a temperature controlled bath with super-perfusion flow. B) Gross pathology of ablative lesions on the endocardial surface of swine right ventricle. (Pins demarcate ends of ablative lesions) C) Optical coherence tomography (OCT) system. D) Representative OCT image of a seven millimeter image of ablative lesion and adjacent tissue. E) TTC stain of ablative lesion shown in panel (D). White necrotic tissue of ablative lesion and red viable tissue are demonstrated.

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Figure 2. Dark band due to tissue birefringence a-b) OCT images of an untreated site obtained with different polarization states of the sample arm light. . Location of band moves as the polarization state in the sample arm is changed. Birefringence dependent bands are highlighted with green arrows. (Media 1) c) Representative OCT image of an ablation lesion. d-f) Decimated and flattened version of images shown in a-c. Region of interest, 525μm, used in analysis shown in panel e as white horizontal lines. g-j) Representative averaged axial scans from the sites indicated in e-h, shows change in location of the band within axial scans of untreated site (g and h). No band in OCT image of ablation lesion. Images acquired with time domain (TDOCT) system.

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Figure 3. A) Temperature duration curve. Catheter-tissue temperature increased monotonically over time, up to a maximal temperature of 70 degrees Celsius. B) Impedance measurements during RF ablation. Impedance measured at the catheter tissue interface decreased during RF applications, consistent with formation of lesions. C) Strength duration curve. Power was consistent throughout the RF applications at 25 Watts. D). Lesion development over time. The depth of the lesion created by RF increased with longer duration of RF application. Results +/- 95% CI

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Figure 4. Representative OCT images of untreated ventricular endocardium. Birefringence band is visible within images of untreated tissue (indicated by green arrows in panel A). Right ventricle (A,B), left ventricle (C,D), and right ventricular septum (E,F). Images acquired with time domain (TDOCT) system.

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Figure 5. Representative OCT images of endocardial radiofrequency ablation lesions. Pins are placed along the ends of the lesion and are visible within OCT images. Yellow dotted lines indicate the area of the RFA lesion. Ablation lesions are characterized by increased signal intensity and absence of polarization artifact. Right ventricle (A,B), left ventricle (C,D), and right ventricular septum (E,F). Images acquired with time domain (TDOCT) system.

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Figure 6. Distinguishing ablation lesions and untreated tissue using gradient strength. a) Scatter plot for each image within the TDOCT dataset, with gradient strength on the x-axis and intensity on the y-axis. Ablation lesions (open shapes), untreated tissue (filled shapes). Left ventricle - circle, right ventricle - square, ventricular septum - triangle B) Receiver operator characteristic (ROC) curve for gradient strength to distinguish ablation lesions from untreated tissue. Lesions can be distinguished from untreated samples within all sites using gradient strength as a discriminating factor, with a 0.94 area under curve (AUC). C) ROC curve for intensity. Intensity had a low classification power to distinguish ablation lesions from untreated tissue, with a 0.72 AUC.

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Figure 7. Gap of untreated tissue within linear ablation line characterized by band due to polarization artifact. a) The gap of untreated tissue was characterized by a strong birefringence dependent band. b) TTC vital staining of ablation two ablation lesions with gap of untreated tissue. c) OCT image decimated to 512 × 13 pixels. d-f) Representative averaged axial scans from decimated image within areas with lesion (d,f) and untreated tissue (e). Band is observed within area of treated tissue and not ablation lesions. Images acquired with microscope integrated Fourier Domain (FDOCT) system.

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Figure 8. Representative OCT images of the endocardium with visualization of “over treated” RFA lesions. Disruptions within the endocardium and myocardium are visible, and may be precursors to steam pops and crater formation. Yellow dotted lines circumscribe each lesion. Images acquired with time domain (TDOCT) system.

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