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Intracardiac acoustic radiation force impulse imaging: a novel imaging method for intraprocedural evaluation of radiofrequency ablation lesions.

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Date
2012-11
Authors
Eyerly, Stephanie A
Bahnson, Tristram D
Koontz, Jason I
Bradway, David P
Dumont, Douglas M
Trahey, Gregg E
Wolf, Patrick D
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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 article
Subject
Animals
Cardiac Surgical Procedures
Catheter Ablation
Dogs
Elasticity Imaging Techniques
Image Enhancement
Image Processing, Computer-Assisted
Intraoperative Period
Myocardium
Sensitivity and Specificity
Permalink
https://hdl.handle.net/10161/10365
Published Version (Please cite this version)
10.1016/j.hrthm.2012.07.003
Publication 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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Scholars@Duke

Bahnson

Tristram Dan Bahnson

Professor of Medicine
Bradway

David Bradway

Research Scientist
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.
Koontz

Jason Koontz

Associate Professor of Medicine
Trahey

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.
Wolf

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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