Treatment of cardiac arrhythmia using Ultrasound guided High Intensity Focused Ultrasound – CardioUSgHIFU

Over recent years, High Intensity Focused Ultrasound (HIFU) has become an increasingly attractive therapeutic modality. By using focused ultrasound waves, HIFU is able to create targeted thermal coagulation of tissues at a very well-defined focus without affecting intervening and surrounding tissues. With recent technological advances, clinical devices have been developed leading to the treatment of benign and malignant tumors of the prostate, liver, bladder, kidney, uterus, breast and pancreas, but little attention has been directed to cardiac applications. In the treatment of cardiac arrhythmia, a major public health burden, HIFU could offer a unique therapeutic solution with important advantages over current approaches such as surgery or Radio-Frequency (RF) catheter ablation: HIFU can target tissues at specific depths in order to create well controlled transmural lesions. Moreover, HIFU can be combined with real-time ultrasound imaging such as standard ultrasound imaging modes or more recently developed, shear wave imaging in order to target, monitor the treatment, and finally assess the lesion extent in post-treatment.
Thermal ablation of cardiac tissues with HIFU remains however a big technological challenge. The main reasons are the difficulty of targeting cardiac tissues (in particular in left and right atrium) using minimal or non-invasive HIFU devices, the complex geometry of the heart cavities and rapid motion of the beating heart. Approaches previously developed for other organs have been shown ineffective for the ablation of cardiac tissues, so that specific approaches are required for this challenging application. The objective of this project is to develop novel, clinically reliable and efficient approaches for the treatment of cardiac arrhythmia using UltraSound guided HIFU (USgHIFU) ablation. Two different approaches (Transoesophageal and intracardiac) for atrial fibrillation treatments are proposed in the framework of this project and will be developed up to a proof of concept on a large animal model. The reason for these two different approaches rely on their potential advantages and risks. On one hand, the transoesophageal approach is extremely attractive due to its non invasive characteristic but is clinically challenging due to potential risks of oesophage damage if not properly implemented. On the other hand, the intracardiac is clinically less risky as the intracardiac therapeutic probe is located near the targeted area, but the technological issue is more risky as it requires the development of a therapy/imaging probe of small dimensions. Both approaches will benefit greatly from integrated ultrasound imaging guidance and monitoring.
The combination of four internationally recognized partners will create the synergy needed for this challenging project: Vermon is a world leader in the design and manufacture of ultrasound transducers, INSERM U1032 LabTau is specialized in the development of minimally invasive ultrasound therapeutic applications, Institut Langevin is recognized for its expertise in wave physics and novel ultrasound based imaging/therapy modalities, and LTSI INSERM U642 in the field of image processing. In addition, preclinical tests on animals will be conducted in collaboration with the teams of Prof. Haissaguerre in Bordeaux, and Prof. Chevalier in Lyon, major clinical groups pioneer in the field of cardiac arrhythmia and ablation.