Quantitative evaluation of atrial radio frequency ablation using intracardiac shear‐wave elastography

Purpose: Radio frequency catheter ablation (RFCA) is a well‐established clinical procedure for the treatment of atrial fibrillation (AF) but suffers from a low single‐procedure success rate. Recurrence of AF is most likely attributable to discontinuous or nontransmural ablation lesions. Yet, despite...

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Bibliographic Details
Published in:Medical physics (Lancaster) 2014-11, Vol.41 (11), p.112901-n/a
Main Authors: Kwiecinski, Wojciech, Provost, Jean, Dubois, Rémi, Sacher, Frédéric, Haïssaguerre, Michel, Legros, Mathieu, Nguyen‐Dinh, An, Dufait, Rémi, Tanter, Mickaël, Pernot, Mathieu
Format: Article
Language:English
Subjects:
Animals
atrial fibrillation
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological material, e.g. blood, urine
Haemocytometers
biological tissues
biomechanics
biomedical transducers
biomedical ultrasonics
Cardiac dynamics
cardiology
Catheter Ablation - methods
Catheters
Catheters
Hollow probes
Diagnosis using ultrasonic, sonic or infrasonic waves
Elastic moduli
Elasticity Imaging Techniques - methods
Heart
Heart - physiology
Heart Atria - pathology
Heating by electric, magnetic, or electromagnetic fields
Humans
Image Processing, Computer-Assisted - methods
intracardiac echocardiography
Mechanical and electrical properties of tissues and organs
Myocardium - pathology
Pathology
Pressure
Processes or apparatus for generating mechanical vibrations of infrasonic, sonic or ultrasonic frequency
radiation therapy
Radio Waves
radiofrequency heating
shear modulus
Shear Strength
shear‐wave elastography
Sheep
Signal Processing, Computer-Assisted
Stress, Mechanical
surgery
Surgical instruments, devices or methods, e.g. tourniquets
Therapeutic applications
thermal ablation monitoring
Thermal imaging
Tissue ablation
Tissues
Transducers
ultrasonic transducer arrays
Ultrasonographic imaging
Ultrasonography
ultrasound
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Summary:Purpose: Radio frequency catheter ablation (RFCA) is a well‐established clinical procedure for the treatment of atrial fibrillation (AF) but suffers from a low single‐procedure success rate. Recurrence of AF is most likely attributable to discontinuous or nontransmural ablation lesions. Yet, despite this urgent clinical need, there is no clinically available imaging modality that can reliably map the lesion transmural extent in real time. In this study, the authors demonstrated the feasibility of shear‐wave elastography (SWE) to map quantitatively the stiffness of RFCA‐induced thermal lesions in cardiac tissues in vitro and in vivo using an intracardiac transducer array. Methods: SWE was first validated in ex vivo porcine ventricular samples (N = 5). Both B‐mode imaging and SWE were performed on normal cardiac tissue before and after RFCA. Areas of the lesions were determined by tissue color change with gross pathology and compared against the SWE stiffness maps. SWE was then performed in vivo in three sheep (N = 3). First, the stiffness of normal atrial tissues was assessed quantitatively as well as its variation during the cardiac cycle. SWE was then performed in atrial tissue after RFCA. Results: A large increase in stiffness was observed in ablated ex vivo regions (average shear modulus across samples in normal tissue: 22 ± 5 kPa, average shear‐wave speed (ct): 4.5 ± 0.4 m s−1 and in determined ablated zones: 99 ± 17 kPa, average ct: 9.0 ± 0.5 m s−1 for a mean shear modulus increase ratio of 4.5 ± 0.9). In vivo, a threefold increase of the shear modulus was measured in the ablated regions, and the lesion extension was clearly visible on the stiffness maps. Conclusions: By its quantitative and real‐time capabilities, Intracardiac SWE is a promising intraoperative imaging technique for the evaluation of thermal ablation during RFCA.
ISSN:0094-2405
2473-4209
DOI:10.1118/1.4896820