Cardiac radiofrequency ablation tracking using electrical impedance tomography

There is a need for accessible high speed imaging of Radiofrequency (RF) cardiac electrosurgery to improve safety and efficacy of the ablation time course, where lesion information is critical to safety and efficacy but currently lacking in real time. In this paper, Electrical Impedance Tomography (EIT) using existing cardiac EP electrodes was optimised to confirm (1) that removal of measurements with low signal sensitivity leads to improved images and (2) that multiple signal thresholds are needed to track the lesion accurately over time. A novel ventricle-shaped gel phantom with realistic fluid flow to mimic blood flow, lung ventilation and myocardium conductivity was developed to study the capability and motivate transition to in-vivo measurements. When using 8 external (ECG) electrodes, 4 internal coronary sinus electrodes and 4 RF catheter-based electrodes, the optimal setup for sensitivity and dynamic tracking was 77 measurements within an error of 20%. Higher thresholds were more suitable for the earlier phase of the ablation when lesions are small while lower thresholds suited later phases. Patient-specific thresholds could be optimised in pre-surgical planning where detailed anatomical images are available. While the error reported in this initial study appears large, it is a major advance over the current situation for the cardiologist where no real-time lesion visualization is accessible in a regular EP suite/cath lab.