Intracardiac acoustic radiation force impulse imaging: a novel imaging method for intraprocedural evaluation of radiofrequency ablation lesions.
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BACKGROUND: Arrhythmia recurrence after cardiac radiofrequency ablation (RFA) for atrial fibrillation has been linked to conduction through discontinuous lesion lines. Intraprocedural visualization and corrective ablation of lesion line discontinuities could decrease postprocedure atrial fibrillation recurrence. Intracardiac acoustic radiation force impulse (ARFI) imaging is a new imaging technique that visualizes RFA lesions by mapping the relative elasticity contrast between compliant-unablated and stiff RFA-treated myocardium. OBJECTIVE: To determine whether intraprocedure ARFI images can identify RFA-treated myocardium in vivo. METHODS: In 8 canines, an electroanatomical mapping-guided intracardiac echo catheter was used to acquire 2-dimensional ARFI images along right atrial ablation lines before and after RFA. ARFI images were acquired during diastole with the myocardium positioned at the ARFI focus (1.5 cm) and parallel to the intracardiac echo transducer for maximal and uniform energy delivery to the tissue. Three reviewers categorized each ARFI image as depicting no lesion, noncontiguous lesion, or contiguous lesion. For comparison, 3 separate reviewers confirmed RFA lesion presence and contiguity on the basis of functional conduction block at the imaging plane location on electroanatomical activation maps. RESULTS: Ten percent of ARFI images were discarded because of motion artifacts. Reviewers of the ARFI images detected RFA-treated sites with high sensitivity (95.7%) and specificity (91.5%). Reviewer identification of contiguous lesions had 75.3% specificity and 47.1% sensitivity. CONCLUSIONS: Intracardiac ARFI imaging was successful in identifying endocardial RFA treatment when specific imaging conditions were maintained. Further advances in ARFI imaging technology would facilitate a wider range of imaging opportunities for clinical lesion evaluation.
Cardiac Surgical Procedures
Elasticity Imaging Techniques
Image Processing, Computer-Assisted
Sensitivity and Specificity
Published Version (Please cite this version)10.1016/j.hrthm.2012.07.003
Publication InfoBahnson, TD; Bradway, David P; Dumont, DM; Eyerly, SA; Koontz, JI; Trahey, Gregg E; & Wolf, PD (2012). Intracardiac acoustic radiation force impulse imaging: a novel imaging method for intraprocedural evaluation of radiofrequency ablation lesions. Heart Rhythm, 9(11). pp. 1855-1862. 10.1016/j.hrthm.2012.07.003. Retrieved from http://hdl.handle.net/10161/10365.
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David P. Bradway is a research scientist in the Biomedical Engineering Department at Duke University. He earned his Ph.D. in biomedical engineering in 2013 from Duke. Afterward, he was a guest postdoc at the Technical University of Denmark (DTU), supported by a Whitaker International Program Scholarship. He has conducted research internships at the Cleveland Clinic Foundation, Volcano Corporation, and Siemens Healthcare, working on ultrasound research since 2002.
Robert Plonsey Professor of Biomedical Engineering
My laboratory develops and evaluates novel ultrasonic imaging methods. Current projects involve high resolutioon imaging of the breast and mechanical characterization of the breast and cardiovascular system. We conduct phantom, animal, ex vivo and in vivo trials. Current clinical trials involve imaging of soft and hard vascular plaques and mecahnical imaging of breast lesions.
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