Tho Hoang Nguyen

The feasibility of using thermal strain imaging to regulate energy delivery during intracardiac radio-frequency ablation

A method is introduced to monitor cardiac ablative therapy by examining slope changes in the thermal strain curve caused by speed of sound variations with temperature. The sound speed of water-bearing tissue such as cardiac muscle increases with temperature. However, at temperatures above about 50°C, there is no further increase in the sound speed and the temperature coefficient may become slightly negative. For ablation therapy, an irreversible injury to tissue and a complete heart block occurs in the range of 48 to 50°C for a short period in accordance with the well-known Arrhenius equation. Using these two properties, we propose a potential tool to detect the moment when tissue damage occurs by using the reduced slope in the thermal strain curve as a function of heating time. We have illustrated the feasibility of this method initially using porcine myocardium in vitro. The method was further demonstrated in vivo, using a specially equipped ablation tip and an 11-MHz microlinear intracardiac echocardiography (ICE) array mounted on the tip of a catheter. The thermal strain curves showed a plateau, strongly suggesting that the temperature reached at least 50°C.

First in vivo use of a capacitive micromachined ultrasound transducer array-based imaging and ablation catheter.

The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML‐CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)‐derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures.

Monitoring radiofrequency catheter ablation using thermal strain imaging

A method to monitor ablative therapy by examining slope changes in the thermal strain curve caused by speed of sound with temperature is introduced. The variation of sound speed with temperature rise for most soft tissue follows a similar pattern to that of water. Unlike most liquids, the sound speed of tissue increases with temperature. However, at temperatures above about 50 °C, there is no further increase in the sound speed and the temperature coefficient may become slightly negative. For ablation therapy, an irreversible injury to tissue and a complete heart block occurs in the range of 48–50 °C for a short period in accordance with the well known Arrhenius equation. Using these two properties, we propose a potential tool to detect the moment when tissue damage occurs using the reduced slope in the thermal strain curve as a function of heating time. Using a prototype intracardiac echocardiography (ICE) array for imaging and a catheter for RF ablation, we were able to observe an obvious slope change in the thermal strain curve in an excised tissue sample. The method was further tested in-vivo, using a specially equipped ablation tip and an 11 MHz microlinear (ML) ICE array mounted on the tip of a catheter. As with in-vitro experiments, the thermal strain curve showed a plateau and a change in the sign of the slope.