Direct imaging of transvenous radiofrequency cardiac ablation using a steerable fiberoptic infrared endoscope.
BACKGROUND
Direct imaging through blood has been achieved in vivo using fiberoptics and infrared wavelength technology.


OBJECTIVE
The purpose of this study was to determine the feasibility of using a percutaneous, steerable, fiberoptic infrared endoscope to identify and characterize the electrode-tissue interface during transvenous cardiac ablation.


METHODS
Infrared endoscopy was performed during 24 catheter ablation attempts in 10 mongrel dogs. Infrared imaging was performed through a transparent dome located at the tip of a 7Fr steerable endoscope using an imaging wavelength of 1,620 nm. Radiofrequency ablation was performed using a 4-mm-tip electrode catheter. Attempts were made to identify the electrode-endocardial interface at each ablation site and to characterize any signal changes during ablation.


RESULTS
The electrode-tissue interface could be identified at 19 of the 24 ablation sites. Changes at the electrode-tissue interface were observed during ablation at 14 sites, which included a gradual increase in the tissue signal intensity at 12 sites. Small lucencies near the ablation electrode were observed at six sites. There was no interference during energy delivery. Endocardial features identified by endoscopy correlated with the postmortem appearance.


CONCLUSIONS
Direct imaging of intracardiac structures and the electrode-tissue interface can be achieved through blood during transvenous catheter ablation with infrared endoscopy using a steerable, fiberoptic, infrared endoscopic catheter. Ablation lesion formation can be seen as a gradual increase in signal intensity. Fiberoptic infrared endoscopy appears to be a promising new tool for guiding catheter ablation.
Knight
Bradley P
BP
Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA. bknight@medicine.bsd.uchicago.edu
Burke
Martin C
MC
Hong
Thomas E
TE
McAuley
Al
A
Amundson
David
D
Hanlin
John
J
Blankenship
Larry
L
Ferguson
T Bruce
TB
Nazarian
Saman
S
Berger
Ronald D
RD
D000818:Animals; D001145:Arrhythmias, Cardiac / Q000628:therapy; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004285:Dogs; D004567:Electrodes, Implanted; D004699:Endocardium / Q000473:pathology / Q000601:surgery; D004724:Endoscopy; D004867:Equipment Design; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology / Q000601:surgery; D000078702:Radiofrequency Therapy