Skip to main content

Advertisement

SpringerLink
Log in

A Percutaneous Catheter for In Vivo Hyperspectral Imaging of Cardiac Tissue: Challenges, Solutions and Future Directions

  • Original Article
  • Published:
Cardiovascular Engineering and Technology Aims and scope Submit manuscript

Abstract

Purpose

Multiple studies have shown that spectral analysis of tissue autofluorescence can be used as a live indicator for various pathophysiological states of cardiac tissue, including ischemia, ablation-induced damage, or scar formation. Yet today there are no percutaneous devices that can detect autofluorescence signals from inside a beating heart. Our aim was to develop a prototype catheter to demonstrate the feasibility of doing so.

Methods and Results

Here we summarize technical solutions leading to the development of a percutaneous catheter capable of multispectral imaging of intracardiac surfaces. The process included several iterations of light sources, optical filtering, and image acquisition techniques. The developed system included a compliant balloon, 355 nm laser irradiance, a high-sensitivity CCD, bandpass filtering, and image acquisition synchronized with the cardiac cycle. It enabled us to capture autofluorescence images from multiple spectral bands within the visible range while illuminating the endocardial surface with ultraviolet light. Principal component analysis and other spectral unmixing post-processing algorithms were then used to reveal target tissue.

Conclusion

Based on the success of our prototype system, we are confident that the development of ever more sensitive cameras, recent advances in tunable filters, fiber bundles, and other optical and computational components makes it possible to create percutaneous catheters capable of acquiring hyper or multispectral hypercubes, including those based on autofluorescence, in real-time. This opens the door for widespread use of this methodology for high-resolution intraoperative imaging of internal tissues and organs—including cardiovascular applications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10

Similar content being viewed by others

Abbreviations

AF:

Atrial fibrillation

Auf-HSI:

Autofluorescence hyperspectral imaging

CCD:

Charged coupled device

LA:

Left atrium

LCTF:

Liquid crystal tunable filter

LED:

Light emitting diode

NADH:

Nicotinamide adenine dinucleotide

RF:

Radiofrequency

UV:

Ultraviolet Light

References

  1. Ahmad, I., A. Gribble, M. Ikram, M. Pop, and A. Vitkin. Polarimetric assessment of healthy and radiofrequency ablated porcine myocardial tissue. J. Biophotonics 9:750–759, 2016.

    Google Scholar 

  2. Akoum, N., M. Daccarett, C. McGann, N. Segerson, G. Vergara, S. Kuppahally, T. Badger, N. Burgon, T. Haslam, E. Kholmovski, R. Macleod, and N. Marrouche. Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J. Cardiovasc. Electrophysiol. 22:16–22, 2011.

    Google Scholar 

  3. Aldhoon, B., T. Kučera, N. Smorodinová, J. Martínek, V. Melenovský, and J. Kautzner. Associations between cardiac fibrosis and permanent atrial fibrillation in advanced heart failure. Physiol. Res. 62:247–255, 2013.

    Google Scholar 

  4. Andreu, D., A. Berruezo, J. T. Ortiz-Pérez, E. Silva, L. Mont, R. Borràs, T. M. de Caralt, R. J. Perea, J. Fernández-Armenta, H. Zeljko, and J. Brugada. Integration of 3D electroanatomic maps and magnetic resonance scar characterization into the navigation system to guide ventricular tachycardia ablation clinical perspective. Circ. Arrhythm. Electrophysiol. 4:674–683, 2011.

    Google Scholar 

  5. Asfour, H., M. Aljishi, T. Chahbazian, L. M. Swift, N. Muselimyan, D. Gil, and N. A. Sarvazyan. Comparison between autofluorescence and reflectance-based hyperspectral imaging for visualization of atrial ablation lesions. Biophys. J. 110:493a–494a, 2016.

    Google Scholar 

  6. Asfour, H., S. Guan, N. Muselimyan, L. Swift, M. Loew, and N. Sarvazyan. Optimization of wavelength selection for multispectral image acquisition: a case study of atrial ablation lesions. Biomed. Opt. Express 9:2189–2204, 2018.

    Google Scholar 

  7. Bunch, T. J., J. P. Weiss, B. G. Crandall, J. D. Day, J. P. Dimarco, J. D. Ferguson, P. K. Mason, G. McDaniel, J. S. Osborn, D. Wiggins, and S. Mahapatra. Image integration using intracardiac ultrasound and 3D reconstruction for scar mapping and ablation of ventricular tachycardia. J. Cardiovasc. Electrophysiol. 21:678–684, 2010.

    Google Scholar 

  8. Calkins, H., G. Hindricks, R. Cappato, Y. H. Kim, E. B. Saad, L. Aguinaga, J. G. Akar, V. Badhwar, J. Brugada, J. Camm, P. S. Chen, S. A. Chen, M. K. Chung, J. C. Nielsen, A. B. Curtis, D. W. Davies, J. D. Day, A. d’Avila, N. M. S(. Natasja de Groot, L. Di Biase, M. Duytschaever, J. R. Edgerton, K. A. Ellenbogen, P. T. Ellinor, S. Ernst, G. Fenelon, E. P. Gerstenfeld, D. E. Haines, M. Haissaguerre, R. H. Helm, E. Hylek, W. M. Jackman, J. Jalife, J. M. Kalman, J. Kautzner, H. Kottkamp, K. H. Kuck, K. Kumagai, R. Lee, T. Lewalter, B. D. Lindsay, L. Macle, M. Mansour, F. E. Marchlinski, G. F. Michaud, H. Nakagawa, A. Natale, S. Nattel, K. Okumura, D. Packer, E. Pokushalov, M. R. Reynolds, P. Sanders, M. Scanavacca, R. Schilling, C. Tondo, H. M. Tsao, A. Verma, D. J. Wilber, and T. Yamane. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Hear. Rhythm 33(5):369–409, 2017.

    Google Scholar 

  9. Cappato, R., H. Calkins, S.-A. A. Chen, W. Davies, Y. Iesaka, J. Kalman, Y.-H. H. Kim, G. Klein, A. Natale, D. Packer, A. Skanes, F. Ambrogi, and E. Biganzoli. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ. Arrhythm. Electrophysiol. 3:32–38, 2010.

    Google Scholar 

  10. Dana, N., L. Di Biase, A. Natale, S. Emelianov, and R. Bouchard. In vitro photoacoustic visualization of myocardial ablation lesions. Heart Rhythm 11:150–157, 2013.

    Google Scholar 

  11. Deng, H., Y. Bai, A. Shantsila, L. Fauchier, T. S. Potpara, and G. Y. H. Lip. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clin. Res. Cardiol. 106(10):813–823, 2017.

    Google Scholar 

  12. Dooley, K. A., S. Lomax, J. G. Zeibel, C. Miliani, P. Ricciardi, A. Hoenigswald, M. H. Loew, and J. K. Delaney. Mapping of egg yolk and animal skin glue paint binders in Early Renaissance paintings using near infrared reflectance imaging spectroscopy. Analyst 138:4838–4848, 2013.

    Google Scholar 

  13. Dukkipati, S. R., F. Cuoco, I. Kutinsky, A. Aryana, T. D. Bahnson, D. Lakkireddy, I. Woollett, Z. F. Issa, A. Natale, and V. Y. Reddy. Pulmonary vein isolation using the visually guided laser balloon. J. Am. Coll. Cardiol. 66:1350–1360, 2015.

    Google Scholar 

  14. Falco, N. An ICA based approach to hyperspectral image feature reduction. In: Geoscience Remote, 2014.

  15. Fleming, C. P., H. Wang, K. J. Quan, and A. M. Rollins. Real-time monitoring of cardiac radio-frequency ablation lesion formation using an optical coherence tomography forward-imaging catheter. J. Biomed. Opt. 15:030516, 2010.

    Google Scholar 

  16. Gaudi, S., R. Meyer, J. Ranka, J. C. Granahan, S. A. Israel, T. R. Yachik, and D. M. Jukic. Hyperspectral imaging of melanocytic lesions. Am. J. Dermatopathol. 36(2):131–136, 2014.

    Google Scholar 

  17. Germano, G., and D. S. Berman. Clinical Gated Cardiac SPECT. Armonk: Blackwell Futura, 2006.

    Google Scholar 

  18. Gil, D. A., L. M. Swift, H. Asfour, N. Muselimyan, M. A. Mercader, and N. A. Sarvazyan. Autofluorescence hyperspectral imaging of radiofrequency ablation lesions in porcine cardiac tissue. J. Biophotonics 10:1008–1017, 2017.

    Google Scholar 

  19. Guan, S., H. Asfour, N. Sarvazyan, and M. Loew. Application of unsupervised learning to hyperspectral imaging of cardiac ablation lesions. J. Med. Imaging 5:1, 2018.

    Google Scholar 

  20. Guan, S., M. Loew, H. Asfour, N. Sarvazyan, and N. Muselimyan, Lesion detection for cardiac ablation from auto-fluorescence hyperspectral images. In: Progress in Biomedical Optics and Imaging—Proceedings of SPIE, 2018, Vol. 10578.

  21. Holmes, J. W., T. K. Borg, and J. W. Covell. Structure and mechanics of healing myocardial infarcts. Annu. Rev. Biomed. Eng. 7:223–253, 2005.

    Google Scholar 

  22. Iskander-Rizk, S., P. Kruizinga, A. F. W. van der Steen, and G. van Soest. Spectroscopic photoacoustic imaging of radiofrequency ablation in the left atrium. Biomed. Opt. Express 9:1309–1322, 2018.

    Google Scholar 

  23. Kiyotoki, S., J. Nishikawa, T. Okamoto, K. Hamabe, M. Saito, A. Goto, Y. Fujita, Y. Hamamoto, Y. Takeuchi, S. Satori, and I. Sakaida. New method for detection of gastric cancer by hyperspectral imaging: a pilot study. J. Biomed. Opt. 18:26010, 2013.

    Google Scholar 

  24. Lo, L.-W. W., and S.-A. A. Chen. Three-dimensional electroanatomic mapping systems in catheter ablation of atrial fibrillation. Circ. J. 74:18–23, 2010.

    Google Scholar 

  25. Lu, G., and B. Fei. Medical hyperspectral imaging: a review. J. Biomed. Opt. 19:10901, 2014.

    Google Scholar 

  26. Magnani, J. W., M. Rienstra, H. Lin, M. F. Sinner, S. A. Lubitz, D. D. McManus, J. Dupuis, P. T. Ellinor, and E. J. Benjamin. Atrial fibrillation: current knowledge and future directions in epidemiology and genomics. Circulation 124(18):1982–1993, 2011.

    Google Scholar 

  27. McGann, C. J., E. G. Kholmovski, R. S. Oakes, J. J. E. Blauer, M. Daccarett, N. Segerson, K. J. Airey, N. Akoum, E. Fish, T. J. Badger, E. V. R. DiBella, D. Parker, R. S. MacLeod, and N. F. Marrouche. New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation. J. Am. Coll. Cardiol. 52:1263–1271, 2008.

    Google Scholar 

  28. Muselimyan, N., M. Al Jishi, H. Asfour, L. Swift, and N. A. Sarvazyan. Anatomical and optical properties of atrial tissue: search for a suitable animal model. Cardiovasc. Eng. Technol. 8:505–514, 2017.

    Google Scholar 

  29. Muselimyan, N., L. M. Swift, H. Asfour, T. Chahbazian, R. Mazhari, M. Mercader, and N. A. Sarvazyan. Seeing the invisible: revealing atrial ablation lesions using hyperspectral imaging approach. PLoS ONE 11:e0167760, 2016.

    Google Scholar 

  30. Nazarian, S., and R. Beinart. CMR-guided targeting of gaps after initial pulmonary vein isolation. JACC. Cardiovasc. Imaging 7:664–666, 2014.

    Google Scholar 

  31. Nelson, C., J. McCrohon, F. Khafagi, S. Rose, R. Leano, and T. H. Marwick. Impact of scar thickness on the assessment of viability using dobutamine echocardiography and thallium single-photon emission computed tomography. J. Am. Coll. Cardiol. 43:1248–1256, 2004.

    Google Scholar 

  32. Park, S. Y., R. P. Singh-Moon, E. Y. Wan, and C. P. Hendon. Towards real-time multispectral endoscopic imaging for cardiac lesion quality assessment. Biomed. Opt. Express 10(6):2829–2846, 2019.

    Google Scholar 

  33. Prabhu, S. D., and N. G. Frangogiannis. The biological basis for cardiac repair after myocardial infarction. Circ. Res. 119:91–112, 2016.

    Google Scholar 

  34. Rijnierse, M. T., C. P. Allaart, and P. Knaapen. Principles and techniques of imaging in identifying the substrate of ventricular arrhythmia. J. Nucl. Cardiol. 23:218–234, 2016.

    Google Scholar 

  35. Schade, A., J. Krug, A.-G. Szöllösi, M. El Tarahony, and T. Deneke. Pulmonary vein isolation with a novel endoscopic ablation system using laser energy. Expert Rev. Cardiovasc. Ther. 10:995–1000, 2012.

    Google Scholar 

  36. Shiba, Y., S. Fernandes, W.-Z. Zhu, D. Filice, V. Muskheli, J. Kim, N. J. Palpant, J. Gantz, K. W. Moyes, H. Reinecke, B. Van Biber, T. Dardas, J. L. Mignone, A. Izawa, R. Hanna, M. Viswanathan, J. D. Gold, M. I. Kotlikoff, N. A. Sarvazyan, M. W. Kay, C. E. Murry, and M. A. Laflamme. Human ES-cell-derived cardiomyocytes electrically couple and suppress arrhythmias in injured hearts. Nature 489:332–335, 2012.

    Google Scholar 

  37. Singh-Moon, R. P., C. C. Marboe, and C. P. Hendon. Near-infrared spectroscopy integrated catheter for characterization of myocardial tissues: preliminary demonstrations to radiofrequency ablation therapy for atrial fibrillation. Biomed. Opt. Express 6:2494, 2015.

    Google Scholar 

  38. Swift, L. M., H. Asfour, N. Muselimyan, C. Larson, K. Armstrong, and N. A. Sarvazyan. Hyperspectral imaging for label-free in vivo identification of myocardial scars and sites of radiofrequency ablation lesions. Hear. Rhythm 15:564–575, 2018.

    Google Scholar 

  39. Tarabalka, Y., J. A. Benediktsson, and J. Chanussot. Spectral–spatial classification of hyperspectral imagery based on partitional clustering techniques. IEEE Trans. Geosci. Remote Sens. 47:2973–2987, 2009.

    Google Scholar 

  40. Tate, T. H., M. Keenan, J. Black, U. Utzinger, and J. K. Barton. Ultraminiature optical design for multispectral fluorescence imaging endoscopes. J. Biomed. Opt. 22(3):036013, 2017.

    Google Scholar 

  41. Tsutsui, N., M. Yoshida, E. Ito, H. Ohdaira, M. Kitajima, and Y. Suzuki. Laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System with intraoperative fluorescent imaging for acute cholecystitis: a case report. Ann. Med. Surg. 35:146–148, 2018.

    Google Scholar 

  42. Zhao, X., X. Fu, C. Blumenthal, Y. T. Wang, M. W. Jenkins, C. Snyder, M. Arruda, and A. M. Rollins. Integrated RFA/PSOCT catheter for real-time guidance of cardiac radio-frequency ablation. Biomed. Opt. Express 9(12):6400–6411, 2018.

    Google Scholar 

  43. Zhao, X., O. Kilinc, C. J. Blumenthal, D. Dosluoglu, M. W. Jenkins, C. S. Snyder, M. Arruda, and A. M. Rollins. Intracardiac radiofrequency ablation in living swine guided by polarization-sensitive optical coherence tomography. J. Biomed. Opt. 25(5):056001, 2020.

    Google Scholar 

Download references

Acknowledgments

We are thankful to our colleagues Drs. Omar Amirana and Narine Muselimyan for useful discussions, expert advice and experimental assistance.

Conflict of interest

Kenneth Armstrong: Employment: Nocturnal Product Development LLC. Funding: HL R41HL12051 & R42HL12051. Stock options: LuxMed Systems. Pending patents: US20150141847A1, US20160120599A1, US201361904018P, US20160143522A1. Granted patents: US9084611B2, US10143517B2. Terrance Ransbury: Employment: LuxMed Systems. Funding: HL R41HL12051 & R42HL12051. Stock options: LuxMed Systems. Pending patents: US20150141847A1, US20160120599A1, US201361904018P, US20160143522A1. Granted patents: US9084611B2, US10143517B2. Cinnamon Larson: Employment: NPD LLC. Funding: HL R41HL12051 & R42HL12051. Stock options: LuxMed Systems. Pending patents: US20150141847A1, US20160120599A1, US201361904018P, US20160143522A1. Granted patents: US9084611B2, US10143517B2. Huda Asfour: Employment: The George Washington University. Funding: HL R41HL12051 & R42HL12051. Narine Sarvazyan: Employment: The George Washington University. Funding: HL R41HL12051 & R42HL12051. Stock options: LuxMed Systems. Pending patents: US20150141847A1, US20160120599A1, US201361904018P. Granted patents: US9014789B2, US9084611B2.

Author information

Authors and Affiliations

  1. Nocturnal Product Development, LLC, 8128 Renaissance Pkwy #210, Durham, NC, 27713, USA

    Kenneth Armstrong & Cinnamon Larson

  2. Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street NW, Washington, DC, 20037, USA

    Huda Asfour & Narine Sarvazyan

  3. LuxMed Systems, Inc, 124 Country Drive, Weston, MA, 02493, USA

    Terry Ransbury

Authors
  1. Kenneth Armstrong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cinnamon Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huda Asfour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Terry Ransbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Narine Sarvazyan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Kenneth Armstrong or Narine Sarvazyan.

Additional information

Associate Editor James E. Moore oversaw the review of this article.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (DOCX 94 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Armstrong, K., Larson, C., Asfour, H. et al. A Percutaneous Catheter for In Vivo Hyperspectral Imaging of Cardiac Tissue: Challenges, Solutions and Future Directions. Cardiovasc Eng Tech 11, 560–575 (2020). https://doi.org/10.1007/s13239-020-00476-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13239-020-00476-w

Keywords

Search

Navigation