High-frequency irreversible electroporation for cardiac ablation using an asymmetrical waveform.

BACKGROUND: Irreversible electroporation (IRE) using direct current (DC) is an effective method for the ablation of cardiac tissue. A major drawback of the use of DC-IRE, however, are two problems: requirement of general anesthesia due to severe muscle contractions and the formation of bubbles containing gaseous products from electrolysis. The use of high-frequency alternating current (HF-IRE) is expected to solve both problems, because HF-IRE produces little to no muscle spasms and does not cause electrolysis. METHODS: In the present study, we introduce a novel asymmetric, high-frequency (aHF) waveform for HF-IRE and present the results of a first, small, animal study to test its efficacy. RESULTS: The data of the experiments suggest that the aHF waveform creates significantly deeper lesions than a symmetric HF waveform of the same energy and frequency (p = 0.003). CONCLUSION: We therefore conclude that the use of the aHF enhances the feasibility of the HF-IRE method.

Correct positioning of central venous catheters using a new electric method.

PURPOSE: In order to find the correct final position of the tip of a central venous catheter, we have developed a new electric method (the Proximity of Cardiac Motion (PCM) method), designed to work in tandem with the existing ECG-based method. METHODS: A small, patient-safe, high-frequency current is fed through the catheter (via the saline-filled lumen of the catheter, or a stylet). Simultaneously, the resulting voltage is measured by two electrodes on the frontal thoracic skin. The catheter tip hence functions as a current source inside the vasculature. The cardiac motion produces a variation in the amplitude of the measured voltage in the rhythm of the cardiac cycle, and the strength of this oscillatory variation is proportional to the strength of the incident current field on the heart, which is a rapidly decaying function of the distance between the catheter tip and the cavoatrial junction (CAJ). Hence the strength of this oscillatory variation is a strong indicator for the proximity of the catheter tip with respect to the CAJ. RESULTS: The new method has been tested in an animal model, yielding an average final position of the catheter tip of 2.1 cm above the CAJ, with a maximum deviation of 0.5 cm. CONCLUSIONS: We conclude that the new PCM method can be combined with the existing ECG method, and may potentially have significant added value when the ECG method cannot be applied, for example, in patients with atrial fibrillation or a pacemaker.

Multiple single-point imaging (mSPI) as a tool for capturing and characterizing MR signals and repetitive signal disturbances with high temporal resolution: the MRI scanner as a high-speed camera.

In this paper we aim to lay down and demonstrate the use of multiple single-point imaging (mSPI) as a tool for capturing and characterizing steady-state MR signals and repetitive disturbances thereof with high temporal resolution. To achieve this goal, various 2D mSPI sequences were derived from the nearest standard 3D imaging sequences by (i) replacing the excitation of a 3D slab by the excitation of a 2D slice orthogonal to the read axis, (ii) setting the readout gradient to zero, and (iii) leaving out the inverse Fourier transform in the read direction. The thus created mSPI sequences, albeit slow with regard to the spatial encoding part, were shown to result into a series of densely spaced 2D single-point images in the time domain enabling monitoring of the evolution of the magnetization with a high temporal resolution and without interference from any encoding gradients. The high-speed capabilities of mSPI were demonstrated by capturing and characterizing the free induction decays and spin echoes of substances with long T2s (>30 ms) and long and short T2*s (4 - >30 ms) and by monitoring the perturbation of the transverse magnetization by, respectively, a titanium cylinder, representing a static disturbance; a pulsed magnetic field gradient, representing a stimulus inherent to a conventional MRI experiment; and a pulsed electric current, representing an external stimulus. The results of the study indicate the potential of mSPI for assessing the evolution of the magnetization and, when properly synchronized with the acquisition, repeatable disturbances thereof with a temporal resolution that is ultimately limited by the bandwidth of the receiver, but in practice governed by the SNR of the experiment and the magnitude of the disturbance. Potential applications of mSPI can be envisaged in research areas that are concerned with MR signal behavior, MR system performance and MR evaluation of magnetically evoked responses.

Front-illuminated versus back-illuminated photon-counting CCD-based gamma camera: important consequences for spatial resolution and energy resolution.

Charge-coupled devices (CCDs) coupled to scintillation crystals can be used for high-resolution imaging with x-rays and gamma rays. When the CCD images can be read out fast enough, the energy and interaction position of individual gamma quanta can be estimated by a real-time image analysis of the scintillation light flashes ('photon-counting mode'). The electron-multiplying CCD (EMCCD) is well suited for fast read out, since even at high frame rates it has extremely low read-out noise. Back-illuminated (BI) EMCCDs have much higher quantum efficiency than front-illuminated (FI) EMCCDs. Here we compare the spatial and energy resolution of gamma cameras based on FI and BI EMCCDs. The CCDs are coupled to a 1000 microm thick columnar CsI(Tl) crystal for the purpose of Tc-99m and I-125 imaging. Intrinsic spatial resolutions of 44 microm for I-125 and 49 microm for Tc-99m were obtained when using a BI EMCCD, which is an improvement by a factor of about 1.2-2 over the FI EMCCD. Furthermore, in the energy spectrum of the BI EMCCD, the I-125 signal could be clearly separated from the background noise, which was not the case for the FI EMCCD. The energy resolution of a BI EMCCD for Tc-99m was estimated to be approximately 36 keV, full width at half maximum, at 141 keV. The excellent results for the BI EMCCD encouraged us to investigate the cooling requirements for our setup. We have found that for the BI EMCCD, the spatial and energy resolution, as well as image noise, remained stable over a range of temperatures from -50 degrees C to -15 degrees C. This is a significant advantage over the FI EMCCD, which suffered from loss of spatial and especially energy resolution at temperatures as low as -40 degrees C. We conclude that the use of BI EMCCDs may significantly improve the imaging capabilities and the cost efficiency of CCD-based high-resolution gamma cameras.