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Development of an Electrophysiology (EP)-Enabled Intracardiac Ultrasound Catheter Integrated With NavX 3-Dimensional Electrofield Mapping for Guiding Cardiac EP Interventions

Experimental Studies

Oregon Health and Science University, Portland, Oregon USA (X.K.L., J.P., R.I.L., M.A., S.B., D.J.S.); GE Global Research, Schenectady, New York USA (K.T., A.D.); University of Southern California, Los Angeles, California USA (K.K.S.); Irvine Biomedical, Inc, Irvine, California USA (R.C.); University of California, Davis, California USA (D.N.S.); University of Washington, Seattle, Washington USA (M.O.); and David Geffen School of Medicine, University of California, Los Angeles, California (A.M., K.S.).

Address correspondence to David J. Sahn, MD, Department of Pediatric Cardiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L608, Portland, OR 97239-3098 USA. E-mail: sahnd{at}ohsu.edu

Objective. We have developed an integrated high-resolution intracardiac echocardiography (ICE) catheter for electrophysiology (EP) testing, which can be coregistered in 3-dimensional space with EP testing and ablation catheters using electrofield sensing. Methods. Twelve open-chest pigs (34–55 kg) and 3 closed-chest pigs were studied. After introduction from the jugular or femoral venous locations, the 9F side-looking, highly steerable (0°–180°), 64-element array catheters could be manipulated easily throughout the right side of the heart. Multisite cardiac pacing was performed for assessing left ventricular (LV) synchrony using tissue Doppler methods. Also, in the open-chest pigs, right atrial (RA) and right ventricular (RV) ablations were performed with a separate radio frequency catheter under fluoroscopic guidance and visualized with ICE to characterize the changes. In the 3 closed-chest pigs, electrofield NavX 3-dimensional coregistration (St Jude Medical Corp, Minneapolis, MN) allowed us to test whether this additional feature could shorten the time necessary to perform 4 targeted ablations in each animal while imaging the ablation catheter and the adjacent region by ICE. Results. Intracardiac anatomy, tricuspid, aortic, pulmonary, and mitral valve function, and pulmonary vein flow were all imaged reproducibly from scanning locations in the RA or RV in all animals, along with assessment of cardiac motion and the effects of multisite pacing. Three-dimensional electrofield displays detailed the spatial relationship between the ICE catheter and ablation catheters such that the time to visualize and ablate 4 sites in each of the 3 closed-chest animals was reduced. Conclusions. This new technology is a first step in the integration of ICE with EP procedures.

Key Words: improved resolution • integrated • intracardiac imaging • rhythm analysis • steerability

Abbreviations: AWG, American wire gauge • EA, electroanatomic • EP, electrophysiology • HS hockey stick • I-box, interface box • ICE, intracardiac echocardiography • LV, left ventricular • RA, right atrial • RF, radio frequency • RV, right ventricular • SRI, strain rate imaging • 3D, 3-dimensional • TDI, tissue Doppler imaging • TSI, tissue synchronization imaging • TVI, tissue velocity imaging • 2D, 2-dimensional

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