Visualization of epicardial cryoablation lesions using endogenous tissue fluorescence.
Visualization of epicardial cryoablation lesions using endogenous tissue fluorescence.
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DOI：
10.1161/circep.114.001750
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Sarvazyan N
中科院分区：
文献类型：
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作者：
Swift L;Gil DA;Jaimes R 3rd;Kay M;Mercader M;Sarvazyan N
经皮冷冻球囊消融术是治疗房颤的常用手术。该手术的主要局限性之一是无法直接观察组织损伤和病变之间的功能间隙。我们寻求开发一种方法，使组织坏死的实时可视化冷冻或射频消融手术。血液灌注或盐水灌注心脏的冷冻消融与NADH荧光的显著降低相关，导致损伤部位信号强度损失60-70%。在NADH通道上观察到的总损伤面积与通过三苯基四唑染色鉴定的面积表现出强相关性（r=0.89，p<0.001）。在生理温度下，冷冻探针从心外膜表面分离后26±8秒内，NADH损失变得明显，并在几分钟内达到稳定状态，之后病变边界保持稳定数小时。冷冻消融部位内的电活动损失与NADH的损失表现出密切的空间相关性（r=0.84±0.06，p<0.001）。冷冻消融导致整个可见光谱的漫反射率降低，这与射频消融形成鲜明对比，射频消融显著增加了病变部位的反射光强度。我们证实了使用内源性NADH荧光实时可视化血液灌注心肌制备的冷冻消融病变的可行性，并揭示了使用紫外线和可见光照明时成像冷冻和射频消融病变之间的相似性和差异。
Percutaneous cryoballoon ablation is a commonly used procedure to treat atrial fibrillation. One of the major limitations of the procedure is the inability to directly visualize tissue damage and functional gaps between the lesions. We seek to develop an approach that will enable real-time visualization of tissue necrosis during cryo- or radiofrequency ablation procedures. Cryoablation of either blood-perfused or saline-perfused hearts was associated with a marked decrease in NADH fluorescence leading to a 60-70% loss of signal intensity at the lesion site. The total lesion area observed on the NADH channel exhibited a strong correlation with the area identified by triphenyl tetrazolium staining (r=0.89, p<0.001). At physiological temperatures, loss of NADH became visually apparent within 26±8 sec after detachment of the cryoprobe from the epicardial surface and plateaued within minutes after which the boundaries of the lesions remained stable for several hours. The loss of electrical activity within the cryoablation site exhibited a close spatial correlation with the loss of NADH (r=0.84±0.06, p<0.001). Cryoablation led to a decrease in diffuse reflectance across the entire visible spectrum which was in stark contrast to radiofrequency ablation that markedly increased the intensity of reflected light at the lesion sites. We confirmed the feasibility of using endogenous NADH fluorescence for the real-time visualization of cryoablation lesions in blood-perfused cardiac muscle preparations and revealed similarities and differences between imaging cryo- and radiofrequency ablation lesions when using ultraviolet and visible light illumination.