Real-time visualization of cardiac ablation lesions using endogenous NADH fluorescence and reflected light
Open AccessAtrial fibrillation remains the most common cardiac arrhythmia and represents a major health issue. Treatment for the condition involves cryo- or radio-frequency ablations delivered by a percutaneous catheter. Ablation therapy uses thermal damage to eliminate sources of aberrant electrical activity and avenues for reentry that can lead to fibrillation. Currently, there are no methods for real-time visualization of the precise location and magnitude of tissue damage during ablation procedures. This often leads to recurrent aberrant activity and patient readmission. This project aimed to develop an imaging approach that could be integrated into ablation catheters allowing direct visualization of tissue damage. The loss of an endogenous intercellular fluorophore, nicotinamide adenine dinucleotide (NADH), was shown to be an accurate indicator of myocardial tissue necrosis and the decline in NADH fluorescence corresponded to a decline in electrical activity. Visualization of NADH fluorescence was effective for delineating both radio-frequency and cryoablation lesions within the surrounding unablated tissue. The approach worked for both blood-free and blood-perfused cardiac preparations. Collagen deposition in healed ablation lesions was shown to interfere with visualization based solely on NADH fluorescence. To address this, diffuse tissue reflectance was successfully used to distinguish between unablated, acutely ablated, and healed ablation sites. A prototype of an imaging catheter was developed based on insights from these studies in hopes of improving treatment outcomes for atrial fibrillation.
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