Catheter ablation is a common treatment for arrhythmia, but can fail if lesion lines are noncontiguous. Identification of gaps and nontransmural lesions can reduce the likelihood of treatment failure and recurrent arrhythmia. Intracardiac myocardial elastography (IME) is a strain imaging technique that provides visualization of the lesion line. Estimation of lesion size and gap resolution were evaluated in an open-chest canine model ( ${n} = 3$ ), and clinical feasibility was investigated in patients undergoing ablation to treat typical cavotricuspid isthmus (CTI) atrial flutter ( ${n} = 5$ ). A lesion line consisting of three lesions and two gaps was generated on the canine left ventricle via epicardial ablation. One lesion was generated in one canine right ventricle. Average lesion and gap areas were measured with high agreement (33 ± 14 and 30 ± 15 mm ² , respectively) when compared against gross pathology (34 ± 19 and 26 ± 11 mm ² , respectively). Gaps as small as 11 mm ² (3.6 mm on epicardial surface) were identifiable. Absolute error and relative error in estimated lesion area were 9.3 ± 8.4 mm ² and 31% ± 34%; error in estimated gap area was 11 ± 9.0 mm ² and 40% ± 29%. Flutter patients were imaged throughout the procedure. Strain was shown to be capable of differentiating between baseline and after ablation completion as confirmed by conduction block. In all patients, strain decreased in the CTI after ablation (mean paired difference of −17% ± 11%, ${p} < 0.05$ ). IME could potentially become a useful ablation monitoring tool in health facilities.

中文翻译：

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犬和​​人的心内应变成像对导管消融病变的可视化

导管消融是心律不齐的常见治疗方法，但如果病变线不连续，则可能会失败。鉴定间隙和非透壁病变可减少治疗失败和复发性心律失常的可能性。心内心肌弹性成像（IME）是一种应变成像技术，可显示病变线。在开胸犬模型中评估病变的大小和间隙的分辨率（ $ {n} = 3 $ ），并在接受消融治疗典型的心房窦峡部（CTI）房扑的患者中研究了临床可行性（ $ {n} = 5 $ ）。通过心外膜消融在犬左心室上形成了由三个病变和两个间隙组成的病变线。在一只犬的右心室中产生了一个病变。 与总体病理（分别为34±19和26±11 mm ²）相比， 平均病变和间隙面积的测量结果具有较高的一致性（分别为33±14和30±15 mm ² ）。可以识别出小至11 mm ²（心外膜表面上的3.6 mm）的间隙 。病变部位的绝对误差和相对误差分别为9.3±8.4 mm ²和31％±34％；估计间隙面积的误差为11±9.0 mm ²和40％±29％。在整个过程中对扑动的患者进行成像。如传导阻滞所证实的，应变被证明能够区分基线和消融完成之后。在所有患者中，消融后CTI的应变均降低（平均配对差为-17％±11％， $ {p} <0.05 $ ）。IME可能会成为医疗机构中有用的消融监测工具。