학술논문
Cardiac Pulsed Field Ablation Lesion Durability Assessed by Polarization-Sensitive Optical Coherence Reflectometry.
Document Type
Academic Journal
Author
Terricabras M; Sunnybrook Research Institute, University of Toronto, ON, Canada (M.T.).; Martins RP; Centre Hospitalier Universitaire de Rennes, Centres d'Investigation Clinique - Innovation Technologique (CIC-IT), Laboratoire Traitement du Signal et de l'Image Institut National de la Santé et de la Recherche Médicale (LTSI INSERM) 1099, University of Rennes, France (R.P.M.).; Peinado R; University Hospital La Paz, Autonomous University of Madrid, Spain (R.P.).; Derejko P; Medicover Hospital, Warsaw, Poland (P.D.).; Mont L; Hospital Clínic, Universitat de Barcelona, Spain (L.M.).; Instituto de Investigaciones Biomèdicas August Pi i Sunyer, Barcelona, Spain (L.M.).; Centro de Investigación en Red Cardiovascular, Madrid, Spain (L.M.).; Ernst S; Royal Brompton Hospital, Imperial College London, United Kingdom (S.E.).; Herranz D; MedLumics S.L., Tres Cantos, Spain (D.H., C.B.).; Bailleul C; MedLumics S.L., Tres Cantos, Spain (D.H., C.B.).; Verma A; McGill University Health Centre, McGill University, Montreal, QC, Canada (A.V.).
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101474365 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-3084 (Electronic) Linking ISSN: 19413084 NLM ISO Abbreviation: Circ Arrhythm Electrophysiol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Pulsed field ablation uses electrical fields to cause nonthermal cell death over several hours. Polarization-sensitive optical coherence reflectometry is an optical imaging technique that can detect changes in the tissue ultrastructure in real time, which occurs when muscular tissue is damaged. The objective of this study was to evaluate the ability of a polarization-sensitive optical coherence reflectometry system to predict the development of chronic lesions based on acute changes in tissue birefringence during pulsed field ablation.
Methods: Superior vena cava isolation was performed in 30 swine using a biphasic, bipolar pulsed field ablation system delivered with a nonirrigated focal tip catheter. Acute changes in tissue birefringence and voltage abatement were analyzed for each individual lesion. A high-resolution electroanatomical map was performed at baseline and 4 to 12 weeks after ablation to locate electrical gaps in the ablated area.
Results: A total of 141 lesions were delivered and included in the analysis. Acute electrical isolation based on the electroanatomical map was achieved in 96% of the animals, but chronic isolation was only seen in 14 animals (46%). The mean voltage abatement of lesions that showed recovery was 82.8%±14.6% versus 84.4%±17.4% for those that showed fibrosis ( P =0.7). The mean acute reduction in tissue birefringence in points demonstrating fibrosis was 63.8%±11.3% versus 9.1%±0.1% in the points that resulted in electrical gaps. A threshold of acute reduction of birefringence of ≥20% could predict chronic lesion formation with a sensitivity of 96% and a specificity of 83%.
Conclusions: Acute tissue birefringence changes assessed with polarization-sensitive optical coherence reflectometry during pulsed field ablation can predict chronic lesion formation and guide the ablation procedure although limited by the tissue thickness.
Competing Interests: Disclosures Drs Herranz and Bailleul are employees of MedLumics S.L. Drs Terricabras, Martins, Peinado, Derejko, Mont, Ernst, and Verma are MedLumics S.L. consultants.
Methods: Superior vena cava isolation was performed in 30 swine using a biphasic, bipolar pulsed field ablation system delivered with a nonirrigated focal tip catheter. Acute changes in tissue birefringence and voltage abatement were analyzed for each individual lesion. A high-resolution electroanatomical map was performed at baseline and 4 to 12 weeks after ablation to locate electrical gaps in the ablated area.
Results: A total of 141 lesions were delivered and included in the analysis. Acute electrical isolation based on the electroanatomical map was achieved in 96% of the animals, but chronic isolation was only seen in 14 animals (46%). The mean voltage abatement of lesions that showed recovery was 82.8%±14.6% versus 84.4%±17.4% for those that showed fibrosis ( P =0.7). The mean acute reduction in tissue birefringence in points demonstrating fibrosis was 63.8%±11.3% versus 9.1%±0.1% in the points that resulted in electrical gaps. A threshold of acute reduction of birefringence of ≥20% could predict chronic lesion formation with a sensitivity of 96% and a specificity of 83%.
Conclusions: Acute tissue birefringence changes assessed with polarization-sensitive optical coherence reflectometry during pulsed field ablation can predict chronic lesion formation and guide the ablation procedure although limited by the tissue thickness.
Competing Interests: Disclosures Drs Herranz and Bailleul are employees of MedLumics S.L. Drs Terricabras, Martins, Peinado, Derejko, Mont, Ernst, and Verma are MedLumics S.L. consultants.