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Intracardiac acoustic radiation force impulse imaging: a novel imaging method for intraprocedural evaluation of radiofrequency ablation lesions.
Abstract
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.
Type
Journal articleSubject
AnimalsCardiac Surgical Procedures
Catheter Ablation
Dogs
Elasticity Imaging Techniques
Image Enhancement
Image Processing, Computer-Assisted
Intraoperative Period
Myocardium
Sensitivity and Specificity
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https://hdl.handle.net/10161/10365Published Version (Please cite this version)
10.1016/j.hrthm.2012.07.003Publication Info
Eyerly, Stephanie A; Bahnson, Tristram D; Koontz, Jason I; Bradway, David P; Dumont,
Douglas M; Trahey, Gregg E; & Wolf, Patrick D (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 https://hdl.handle.net/10161/10365.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Tristram Dan Bahnson
Professor of Medicine
David Bradway
Research Scientist, Senior
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.
Jason Koontz
Associate Professor of Medicine
Gregg E. Trahey
Robert Plonsey Distinguished 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.
Patrick D. Wolf
Associate Professor of Biomedical Engineering
My research is primarily in the area of advanced instrumentation for diagnosis and
treatment of electrophysiological problems. This research covers two primary organ
systems: the heart and the brain.
One thrust of the cardiac-based work is centered on atrial fibrillation and in particular
on very low energy atrial defibrillation strategies. The goal is to produce a device
that can defibrillate the atria with a painless series of electrical impulses. A second
area of interest is the st
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