Ultrasound compatible RF ablation electrode design for catheter based guidance of RF ablation — In vivo results with thermal strain imaging

Abstract

Currently the feedback guidance of intracardiac radiofrequency ablation (RFA) is very limited, offering only a catheter electrode (not tissue) temperature estimation and a means to titrate radiofrequency (RF) power delivery to the tissue. Our "MicroLinear" (ML) forward imaging ultrasound catheter design, now at a true 9F (3mm) in size, has been optimized with several features to simultaneously permit, a) high quality intracardiac steering and imaging, b) tracking of 3D position with electroanatomical mapping, c) RF ablation, and d) tissue thermal strain (TS) estimation for direct tissue temperature feedback. Two types of ML catheters have been built and tested in 3 porcine animal models. The first type, in its third generation, is based on a PZT transducer array; the second type, in its second generation, is based on a CMUT array with custom integrated interface circuitry. Both types of devices are true 9F in size and performed well in imaging tests in recent in vivo studies. Both the ML-PZT and ML-CMUT arrays, as described previously, have a fine pitch (65 and 63 micron respectively) 24 element phased arrays operating at 14 MHz which project a B-mode plane directly out from the tip of the catheter. Intracardiac imaging performance was documented to show that the very small array apertures of the ML design (1.2mm × 1.58mm, and 1.1mm × 1.4mm) permit good, high resolution imaging to depths as great as 4 cm. The ML-PZT catheter was equipped with a special low profile ablation tip which allowed simultaneous imaging and ablation at the distal end of the catheter. TS data were acquired during tissue ablations in right atrium (RA) and right ventricle (RV). The TS data of the RF ablations were processed off line. In vivo use of this new technology has shown for the first time the very substantial potential for a single, low profile catheter to simultaneously image within the heart and perform intracardiac ablation therapy with tissue temperature guidance produced from the incorporation of TS imaging. Work is underway to further assess the temperature estimation accuracy and to integrate the TS processing for real time displays.