Intracardiac radiofrequency ablation in living swine guided by polarization-sensitive optical coherence tomography

Abstract

Pulmonary vein (PV) isolation (PVI) with catheter-based radiofrequency ablation (RFA) is commonly performed to treat atrial fibrillation (AF).¹ The goal of a PVI is to electrically disconnect arrhythmogenic PVs from the left atrium (LA). This is done using RFA to create circular lines of lesions that surround the PVs and isolate them from the LA.² To achieve electrical isolation, lesion transmurality and lesion line continuity are crucial.^{3 – 5} Lesion formation is currently guided with indirect information (e.g., temperature, impedance, and contact force). However, PVI procedures still suffer from a high recurrence rate and complications due to several factors (e.g., nontransmural lesions, steam pops, perforation, and damage to the adjacent area from energy delivery).^3,4,6 Currently, more than half of patients who receive RFA PVI therapy will require additional RFA procedures. Only 17% of patients are arrhythmia-free at 5 years after a single AF ablation procedure. Even with multiple procedures, 2.1 on average, the success rate is approximately 65% after 5 years.⁷ This suggests that direct tissue-measurement guidance may improve PVI efficacy.