PSOCT, NIRS, and optical mapping of low voltage zones in atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia worldwide. An increasingly common treatment option is catheter ablation. During this procedure, the clinician steers a catheter into the left atrium and ablates a lesion fence around the pulmonary veins, a common source of ectopic signals. This lesion fence blocks arrhythmogenic tissue from initiating an erroneous heartbeat. However, if the disease has progressed from paroxysmal to persistent, pathogenic tissue exists throughout the atrium, and common ablation schemes are not as effective. In this case, technologies exist to electroanatomically map the atrium and guide clinicians in targeting adjunctive AF ablation targets. Low voltages mapped in vivo are a well-documented way of identifying atrial fibrosis, an important substrate for AF. Ablating low voltage zones in patients with a more developed disease can help terminate AF and improve long-term outcomes, but low voltage measurements are not specific to fibrosis. Treatment results vary because the targeting that electroanatomical mapping provides is incomplete. Our group has shown that polarization-sensitive optical coherence tomography (PSOCT) and near infrared spectroscopy (NIRS) can monitor lesion formation in vivo and differentiate tissue types in the atrium. Now, we are investigating the technology's utility in identifying AF targets prior to ablation. We have collaborated in developing a swine model of AF that shows the atria remodels during the diseased state. Because of this, we can electroanatomically map these diseased hearts in vivo to measure low voltage zones. Subsequently, we examine the left atrium ex vivo using benchtop PSOCT, NIRS, and optical mapping (OM) and register these optical measurements to the in vivo low voltage zones. We show that OM confirms abnormal conduction, while PSOCT- and NIRS-derived metrics have promise for identifying low voltage zones. We confirm these measures with histological identification of fibrosis. This suggests the feasibility of using PSOCT-NIRS at the catheter tip to detect AF ablation targets.