LASER-INDUCED FLUORESCENCE IDENTIFICATION OF SINOATRIAL AND ATRIOVENTRICULAR NODAL CONDUCTION TISSUE

Transcatheter ablation of nodal tissue is used for the treatment of ar rhythmia resistant to medical therapy. We have investigated the use of laser induced fluorescence spectroscopy for the in vitro recognition of nodal conduction tissue. Twelve fresh human necropsy specimens (< 4 8 hours) were obtained from sinoatrial node and atrioventricular node areas. Spectra were recorded during excitation at 308 nm (XeCl excimer laser, 1.5-2.0 mJ/pulse, 10 Hz). Each area examined was marked for su bsequent histologic examination. Four hundred eleven spectra were obta ined, of which 37 contained nodal conduction tissue (21 sinoatrial, 16 atrioventricular node). Normalized fluorescence emission intensity fr om these areas was compared with that of surrounding endomyocardial ti ssue at 18 wavelengths and 35 ratios of fluorescence intensity at sele cted wavelengths. Spectra recorded from nodal tissue could be clearly distinguished by a visible decrease in fluorescence emission intensity at wavelengths from 440 to 500 nm (P < 0.0006 at 450 nm), peak area, and peak width when compared to that of adjacent atrial endomyocardial tissue. Nodal conduction tissue was also distinguished from ventricul ar endocardium (14 spectra) by an increase in fluorescence emission at 430 to 550 nm (P < 0.0001). The specificity was 73% and 88% and the s ensitivity was 73% and 60% for sinus nodal and atrioventricular nodal conduction tissue identification, respectively. A ratio of fluorescenc e emission intensity > 1.3 for 380/475 nm was able to detect nodal con duction tissue (P < 0.001). Conclusion: Laser induced fluorescence can differentiate nodal conduction tissue from atrial and ventricular end ocardium and may provide a new diagnostic tool for the recognition and subsequent ablation of nodal conduction tissue.