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Mirzajani H, Kraft M. Soft Bioelectronics for Heart Monitoring. ACS Sens 2024; 9:4328-4363. [PMID: 39239948 DOI: 10.1021/acssensors.4c00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Cardiovascular diseases (CVDs) are a predominant global health concern, accounting for over 17.9 million deaths in 2019, representing approximately 32% of all global fatalities. In North America and Europe, over a million adults undergo cardiac surgeries annually. Despite the benefits, such surgeries pose risks and require precise postsurgery monitoring. However, during the postdischarge period, where monitoring infrastructures are limited, continuous monitoring of vital signals is hindered. In this area, the introduction of implantable electronics is altering medical practices by enabling real-time and out-of-hospital monitoring of physiological signals and biological information postsurgery. The multimodal implantable bioelectronic platforms have the capability of continuous heart sensing and stimulation, in both postsurgery and out-of-hospital settings. Furthermore, with the emergence of machine learning algorithms into healthcare devices, next-generation implantables will benefit artificial intelligence (AI) and connectivity with skin-interfaced electronics to provide more precise and user-specific results. This Review outlines recent advancements in implantable bioelectronics and their utilization in cardiovascular health monitoring, highlighting their transformative deployment in sensing and stimulation to the heart toward reaching truly personalized healthcare platforms compatible with the Sustainable Development Goal 3.4 of the WHO 2030 observatory roadmap. This Review also discusses the challenges and future prospects of these devices.
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Affiliation(s)
- Hadi Mirzajani
- Department of Electrical and Electronics Engineering, Koç University, Rumelifeneri Yolu, Sarıyer, Istanbul, 34450 Turkey
| | - Michael Kraft
- Department of Electrical Engineering (ESAT-MNS), KU Leuven, 3000 Leuven, Belgium
- Leuven Institute for Micro- and Nanoscale Integration (LIMNI), KU Leuven, 3001 Leuven, Belgium
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Arefinia E, Jayender J, Patel RV. Machine-Learning-Based Multi-Modal Force Estimation for Steerable Ablation Catheters. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2024; 6:1004-1016. [PMID: 39280352 PMCID: PMC11392016 DOI: 10.1109/tmrb.2024.3407590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Catheter-based cardiac ablation is a minimally invasive procedure for treating atrial fibrillation (AF). Electrophysiologists perform the procedure under image guidance during which the contact force between the heart tissue and the catheter tip determines the quality of lesions created. This paper describes a novel multi-modal contact force estimator based on Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs). The estimator takes the shape and optical flow of the deflectable distal section as two modalities since frames and motion between frames complement each other to capture the long context in the video frames of the catheter. The angle between the tissue and the catheter tip is considered a complement of the extracted shape. The data acquisition platform measures the two-degrees-of-freedom contact force and video data as the catheter motion is constrained in the imaging plane. The images are captured via a camera that simulates single-view fluoroscopy for experimental purposes. In this sensor-free procedure, the features of the images and optical flow modalities are extracted through transfer learning. Long Short-Term Memory Networks (LSTMs) with a memory fusion network (MFN) are implemented to consider time dependency and hysteresis due to friction. The architecture integrates spatial and temporal networks. Late fusion with the concatenation of LSTMs, transformer decoders, and Gated Recurrent Units (GRUs) are implemented to verify the feasibility of the proposed network-based approach and its superiority over single-modality networks. The resulting mean absolute error, which accounted for only 2.84% of the total magnitude, was obtained by collecting data under more realistic circumstances in contrast to previous research studies. The decrease in error is considerably better than that achieved by individual modalities and late fusion with concatenation. These results emphasize the practicality and relevance of utilizing a multimodal network in real-world scenarios.
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Affiliation(s)
- E Arefinia
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada, and Canadian Surgical Technologies and Advanced Robotics (CSTAR), University Hospital, LHSC, London, ON, Canada
| | - J Jayender
- Department of Radiology at Brigham and Women's Hospital, and the Harvard Medical School, Boston, MA 02115, USA
| | - R V Patel
- Department of Electrical and Computer Engineering, Western University, London, ON, Canada, and Canadian Surgical Technologies and Advanced Robotics (CSTAR), University Hospital, LHSC, London, ON, Canada
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3
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Nakagawa H, Castellvi Q, Neal R, Girouard S, Laughner J, Ikeda A, Sugawara M, An Y, Hussein AA, Nakhla S, Taigen T, Srounbek J, Kanj M, Santangeli P, Saliba WI, Ivorra A, Wazni OM. Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries. Circ Arrhythm Electrophysiol 2024; 17:e012026. [PMID: 38152949 DOI: 10.1161/circep.123.012026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model. METHODS A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4-13 g; median, 9.5 g); (2) moderate (15-30 g; median, 21.5 g); (3) high (34-55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining. RESULTS Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact. CONCLUSIONS Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.
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Affiliation(s)
- Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Quim Castellvi
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Q.C., A. Ivorra)
| | - Robert Neal
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Steven Girouard
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Jacob Laughner
- Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.)
| | - Atsushi Ikeda
- Department of Cardiology, Nihon University, Tokyo, Japan (A. Ikeda)
| | - Masafumi Sugawara
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Yoshimori An
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Shady Nakhla
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Jakub Srounbek
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
| | - Antoni Ivorra
- Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Q.C., A. Ivorra)
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.)
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, Romero JE. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:2573-2583. [PMID: 37804258 DOI: 10.1016/j.jacep.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. OBJECTIVES This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. METHODS Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. RESULTS A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. CONCLUSIONS There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
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Affiliation(s)
- Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA; Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Te
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Benjamin D'Souza
- Cardiac Arrythmia Program, Cardiology Service, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Mohit Rastogi
- Electrophysiology Department, Heart and Vascular Service, University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | | | - Laura C Ibanez
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Baran J, Skrzyńska-Kowalczyk M, Piotrowski R, Sikorska A, Kryński T, Kułakowski P. Is catheter-tissue contact force value important for ablation of ventricular arrhythmias originating from the left ventricular papillary muscles? Front Cardiovasc Med 2023; 10:1166810. [PMID: 37273878 PMCID: PMC10235700 DOI: 10.3389/fcvm.2023.1166810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Background Good catheter-tissue contact is mandatory to create effective ablation lesions. The minimal contact force value for ablation of arrhythmias originating from the left ventricle is 8.0-10.0 grams but is not known for arrhythmias arising from papillary muscles. Purpose To analyze contact force values during successful ablation procedures of arrhythmias originating from the left ventricular papillary muscles. Methods 24 consecutive patients (mean age 57.9 ± 11.9 years, 16 males) underwent ablation of premature ventricular complexes originating from left ventricular papillary muscles with the use of CARTO electro-anatomical system and intracardiac echocardiography. Results Acute complete abolition of ventricular ectopy was obtained in 23 (96%) patients. The fluoroscopy time was 3.9 ± 3.5 min and procedure duration - 114.8 ± 37.9 min. The mean contact force during successful ablations was 3.0 ± 1.1 grams and 3.18 ± 1.8 grams for antero-lateral and postero-medial papillary muscle, respectively (NS). The mean contact force during a single unsuccessful ablation was 3.0 grams. At control Holter ECG, the mean Ectopy Burden was Reduced in the Antero-Lateral Papillary Muscle Group from 18.0% ± 7.9% to 2.6% ± 2.9% (p = 0.005415) and in the Postero-Medial Papillary Muscle Group - from 34.8% ± 13.7%-1.7% ± 1.3% (p = 0.012694). During Median 27 (IQR: 17-34) Months of Follow-up There one Recurrence of Arrhythmia. Conclusion The values of contact force for successful ablation of ventricular ectopy originating from the left ventricular papillary muscles may be much lower than those for ablation of other foci which questions the role of contact force measurement when ablating these arrhythmias.
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Affiliation(s)
- Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Martyna Skrzyńska-Kowalczyk
- Department of Internal Medicine and Cardiology University Clinical Center, Medical University of Warsaw, Warsaw, Poland
| | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Kryński
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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Mattison L, Verma A, Tarakji KG, Reichlin T, Hindricks G, Sack KL, Önal B, Schmidt MM, Miklavčič D, Sigg DC. Effect of contact force on pulsed field ablation lesions in porcine cardiac tissue. J Cardiovasc Electrophysiol 2023; 34:693-699. [PMID: 36640426 DOI: 10.1111/jce.15813] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Contact force has been used to titrate lesion formation for radiofrequency ablation. Pulsed field ablation (PFA) is a field-based ablation technology for which limited evidence on the impact of contact force on lesion size is available. METHODS Porcine hearts (n = 6) were perfused using a modified Langendorff set-up. A prototype focal PFA catheter attached to a force gauge was held perpendicular to the epicardium and lowered until contact was made. Contact force was recorded during each PFA delivery. Matured lesions were cross-sectioned, stained, and the lesion dimensions measured. RESULTS A total of 82 lesions were evaluated with contact forces between 1.3 and 48.6 g. Mean lesion depth was 4.8 ± 0.9 mm (standard deviation), mean lesion width was 9.1 ± 1.3 mm, and mean lesion volume was 217.0 ± 96.6 mm3 . Linear regression curves showed an increase of only 0.01 mm in depth (depth = 0.01 × contact force + 4.41, R2 = 0.05), 0.03 mm in width (width = 0.03 × contact force + 8.26, R2 = 0.13) for each additional gram of contact force, and 2.20 mm3 in volume (volume = 2.20 × contact force + 162, R2 = 0.10). CONCLUSION Increasing contact force using a bipolar, biphasic focal PFA system has minimal effects on acute lesion dimensions in an isolated porcine heart model and achieving tissue contact is more important than the force with which that contact is made.
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Affiliation(s)
| | - Atul Verma
- McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | | | - Tobias Reichlin
- Department of Cardiology, Inselspital-University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | | | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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Sohns C, Bergau L, El-Hamriti M, Fox H, Molatta S, Braun M, Khalaph M, Imnadze G, Sommer P. Posterior wall substrate modification using optimized and contiguous lesions in patients with atrial fibrillation. Cardiol J 2022; 29:917-926. [PMID: 33346368 PMCID: PMC9788747 DOI: 10.5603/cj.a2020.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Radiofrequency (RF) linear ablation at the left atrial (LA) roof and bottom to isolate the LA posterior wall using contiguous and optimized RF lesions was evaluated. Achieving isolation of the LA posterior wall is challenging as two continuous linear lesion sets are necessary. METHODS Forty consecutive patients with symptomatic atrial fibrillation (AF) and arrhythmia substrates affecting the LA posterior wall underwent posterior wall isolation by linear lesions across the roof and bottom. The cohort was divided into two groups: group 1 (20 patients) linear ablation guided by contact force (CF) only; group 2 (20 patients) guided by ablation index (AI) and interlesion distance. RESULTS Bidirectional block across the LA roof and bottom was achieved in 40/40 patients. Additional endocardial RF applications in 5 patients from group 1 vs. 3 patients from group 2 resulted in posterior wall isolation in all patients. Procedure duration was almost equal in both groups. CF and AI were significantly higher in group 2 for the roof line, whereas no statistical difference was found for the bottom line. AI-guided LA posterior wall isolation led to a significantly lower maximum temperature increase. The mean AI value as well as the mean value for catheter-to-tissue CF for the roof line were significantly higher when AI-guided ablation was performed. Standard deviation in group 2 showed a remarkably lower dispersion. CONCLUSIONS Ablation index guided posterior wall isolation for substrate modification is safe and effective. AI guided application of the posterior box lesion allows improved lesion formation.
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Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Mustapha El-Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery and Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Nakagawa H, Ikeda A, Yokoyama K, An Y, Hussein AA, Saliba WI, Wazni OM, Castellvi Q. Improvement in Lesion Formation with Radiofrequency Energy and Utilization of Alternate Energy Sources (Cryoablation and Pulsed Field Ablation) for Ventricular Arrhythmia Ablation. Card Electrophysiol Clin 2022; 14:757-767. [PMID: 36396191 DOI: 10.1016/j.ccep.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Current ablation systems rely on thermal energy to produce ablation lesions (heating: RF, laser and ultrasound, and cooling: cryo-thermia). While thermal ablation has been proven to be effective, there are several limitations: 1) relatively long procedural times; 2) high recurrence rate of ventricular arrhythmias; and 3) excessive heating potentially leading to serious complications, including steam pop (perforation), coronary arterial injury and thrombo-embolism. Pulsed field ablation (PFA)/irreversible electroporation (IRE) offers a unique non-thermal ablation strategy which has the potential to overcome these limitations. Recent pre-clinical studies suggest that PFA/IRE might be effective and safe for the treatment of cardiac arrhythmias.
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Affiliation(s)
- Hiroshi Nakagawa
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Atsushi Ikeda
- Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Katsuaki Yokoyama
- Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshimori An
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Quim Castellvi
- Department of Information and Communications Technologies, Pompeu Fabra University, Barcelona, Spain
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9
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Lin WH, Zhu Z, Ravikumar V, Sharma V, Tolkacheva EG, McAlpine MC, Ogle BM. A Bionic Testbed for Cardiac Ablation Tools. Int J Mol Sci 2022; 23:ijms232214444. [PMID: 36430922 PMCID: PMC9692733 DOI: 10.3390/ijms232214444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Bionic-engineered tissues have been proposed for testing the performance of cardiovascular medical devices and predicting clinical outcomes ex vivo. Progress has been made in the development of compliant electronics that are capable of monitoring treatment parameters and being coupled to engineered tissues; however, the scale of most engineered tissues is too small to accommodate the size of clinical-grade medical devices. Here, we show substantial progress toward bionic tissues for evaluating cardiac ablation tools by generating a centimeter-scale human cardiac disk and coupling it to a hydrogel-based soft-pressure sensor. The cardiac tissue with contiguous electromechanical function was made possible by our recently established method to 3D bioprint human pluripotent stem cells in an extracellular matrix-based bioink that allows for in situ cell expansion prior to cardiac differentiation. The pressure sensor described here utilized electrical impedance tomography to enable the real-time spatiotemporal mapping of pressure distribution. A cryoablation tip catheter was applied to the composite bionic tissues with varied pressure. We found a close correlation between the cell response to ablation and the applied pressure. Under some conditions, cardiomyocytes could survive in the ablated region with more rounded morphology compared to the unablated controls, and connectivity was disrupted. This is the first known functional characterization of living human cardiomyocytes following an ablation procedure that suggests several mechanisms by which arrhythmia might redevelop following an ablation. Thus, bionic-engineered testbeds of this type can be indicators of tissue health and function and provide unique insight into human cell responses to ablative interventions.
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Affiliation(s)
- Wei-Han Lin
- Department of Biomedical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Stem Cell Institute, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
| | - Zhijie Zhu
- Department of Mechanical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
| | - Vasanth Ravikumar
- Department of Electrical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
| | - Vinod Sharma
- Cardiac Rhythm and Heart Failure Division, Medtronic Inc., Minneapolis, MN 55432, USA
| | - Elena G. Tolkacheva
- Department of Biomedical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Lillehei Heart Institute, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
| | - Michael C. McAlpine
- Department of Mechanical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Correspondence: (M.C.M.); (B.M.O.)
| | - Brenda M. Ogle
- Department of Biomedical Engineering, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Stem Cell Institute, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Lillehei Heart Institute, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Masonic Cancer Center, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
- Correspondence: (M.C.M.); (B.M.O.)
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10
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Fekri P, Khodashenas H, Lachapelle K, Cecere R, Zadeh M, Dargahi J. Y-Net: A Deep Convolutional Architecture for 3D Estimation of Contact Forces in Intracardiac Catheters. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3148439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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11
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Takamatsu S, Tachibana M, Ii N, Hasui Y, Matsumoto K, Banba K. Proper use of fentanyl facilitates anesthesia during pulmonary vein isolation. Heart Vessels 2022; 37:1034-1043. [PMID: 34993585 DOI: 10.1007/s00380-021-02001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/26/2021] [Indexed: 11/04/2022]
Abstract
Although intraoperative anesthetic management of extensive encircling pulmonary vein isolation (PVI) is essential for the safe performance of this procedure, there is no standardized approach for the use of sedation and analgesia. Therefore, the present study aimed to clarify the optimal fentanyl dosage and timing of administration for the anesthetic management during PVI. A total of 364 patients with atrial fibrillation (AF) who underwent PVI at our institution between June 2017 and October 2020 were recruited. All patients were anesthetized with propofol for induction and maintenance under controlled ventilation via the supraglottic airway without neuromuscular blocking drugs. Among them, 234 patients received less frequent injections (Group 1) and 130 received a scheduled injection of 50 mg of fentanyl (Group 2) in addition to propofol during PVI. We compared the total and additional propofol doses, frequency of additional propofol, and procedure time between the two groups. The mean patient age was 67.2 years, and 69% were male. The total propofol dose was significantly lower in Group 2 than in Group 1 (17.0 ± 5.2 mg/kg vs. 19.0 ± 5.5 mg/kg, p < 0.01). The loading dose and frequency of additional propofol were also significantly lower in Group 2 than in Group 1. The procedure time was significantly shorter in Group 2 than in Group 1 (119 ± 36 min vs. 132 ± 31 min, p < 0.01). During PVI, proper use of fentanyl decreased the propofol dose, additional propofol frequency, and procedure time.
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Affiliation(s)
- Sachiko Takamatsu
- Department of Nursing, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Motomi Tachibana
- Department of Cardiology, Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan.
| | - Nobuhisa Ii
- Department of Nursing, Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yusuke Hasui
- Department of Cardiology, Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
| | - Kensuke Matsumoto
- Department of Cardiology, Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
| | - Kimikazu Banba
- Department of Cardiology, Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, 700-0804, Japan
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12
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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13
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Hao R, Erdem Tuna E, Çavuşoğlu MC. Contact Stability and Contact Safety of a Magnetic Resonance Imaging-Guided Robotic Catheter Under Heart Surface Motion. JOURNAL OF DYNAMIC SYSTEMS, MEASUREMENT, AND CONTROL 2021; 143:071010. [PMID: 33994580 PMCID: PMC8086176 DOI: 10.1115/1.4049837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Contact force quality is one of the most critical factors for safe and effective lesion formation during catheter based atrial fibrillation ablation procedures. In this paper, the contact stability and contact safety of a novel magnetic resonance imaging (MRI)-actuated robotic cardiac ablation catheter subject to surface motion disturbances are studied. First, a quasi-static contact force optimization algorithm, which calculates the actuation needed to achieve a desired contact force at an instantaneous tissue surface configuration is introduced. This algorithm is then generalized using a least-squares formulation to optimize the contact stability and safety over a prediction horizon for a given estimated heart motion trajectory. Four contact force control schemes are proposed based on these algorithms. The first proposed force control scheme employs instantaneous heart position feedback. The second control scheme applies a constant actuation level using a quasi-periodic heart motion prediction. The third and the last contact force control schemes employ a generalized adaptive filter-based heart motion prediction, where the former uses the predicted instantaneous position feedback, and the latter is a receding horizon controller. The performance of the proposed control schemes is compared and evaluated in a simulation environment.
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Affiliation(s)
- Ran Hao
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - E. Erdem Tuna
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - M. Cenk Çavuşoğlu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
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14
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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15
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Sharif ZI, Heist EK. Optimizing Durability in Radiofrequency Ablation of Atrial Fibrillation. J Innov Card Rhythm Manag 2021; 12:4507-4518. [PMID: 34035983 PMCID: PMC8139307 DOI: 10.19102/icrm.2021.120505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/27/2020] [Indexed: 11/06/2022] Open
Abstract
Radiofrequency ablation (RFA) remains a highly effective therapy in the management of paroxysmal atrial fibrillation (PAF) and is an important therapeutic option in the management of persistent atrial fibrillation (PeAF) when clinically indicated. Lesion size is influenced by many parameters, which include those related to energy application (RFA power, temperature, and time), delivery mechanism (electrode size, orientation, and contact force), and the environment (blood flow and local tissue contact, stability, and local impedance). Successful durable RFA is dependent on achieving lesions that are reliably transmural and contiguous, whilst also avoiding injury to the surrounding structures. This review focuses on the variables that can be adjusted in connection with RFA to achieve long-lasting lesions that enable patients to derive the maximum sustained benefit from pulmonary vein isolation and additional lesion sets if utilized.
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Affiliation(s)
- Zain I Sharif
- Clinical Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - E Kevin Heist
- Clinical Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, MA, USA
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16
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Cheng W, Yao M, Zhai B, Wang P. Contact force sensors in minimally invasive catheters: current and future applications. Expert Rev Med Devices 2021; 18:445-455. [PMID: 33886427 DOI: 10.1080/17434440.2021.1917372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Advances in catheter design for minimally invasive surgery have brought about the incorporation of contact force (CF) sensors in catheters. Two main approaches to achieve CF sensing at the catheter end-effector consist of fiber optic or magnetic solutions. CF sensing feedback can be used to assist in ablation procedures, mapping cardiac regions, identifying tissue characteristics, and enhancing robotic catheter control. AREAS COVERED This review covers the technological and clinical aspects of CFS in catheters. Contact force and force-time integral thresholds for ablation procedures, procedural complications, and electroanatomical mapping strategies are discussed. Future applications of improving catheter control, minimizing complications, and enhancing mapping techniques through CF are examined. EXPERT OPINION Fiber optic CF catheters may be more desirable compared to magnetic modalities due to the lower cost, compactness, and higher accuracy. In ablation procedures, complications due to higher ablation duration, power, contact force, and force time can be reduced through practical experience and informed training for catheter operators. Future prospects consist of the incorporation of CF sensors with remote catheter systems to assist in catheter control. We propose that CF can also be used in machine learning decision-making algorithms to prevent complications or improve tissue characterization.
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Affiliation(s)
- Weyland Cheng
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.,Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Manye Yao
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
| | - Penggao Wang
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China
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17
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Yasin R, Simaan N. Joint-level force sensing for indirect hybrid force/position control of continuum robots with friction. Int J Rob Res 2020. [DOI: 10.1177/0278364920979721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Continuum robots offer the dexterity and obstacle circumvention capabilities necessary to enable surgery in deep surgical sites. They also can enable joint-level ex situ force sensing (JEFS), which provides an estimate of end-effector wrenches given joint-level forces. Prior works on JEFS relied on a restrictive embodiment with minimal actuation line friction and captured model and frictional actuation transmission uncertainties using a configuration space formulation. In this work, we overcome these limitations. First, frictional losses are canceled using a feed-forward term based on support vector regression in joint space. Then, regression maps and their interpolation are used to account for actuation hysteresis. The residual joint-force error is then further minimized using a least-squares model parameter update. An indirect hybrid force/position controller using JEFS is presented with evaluation carried out on a realistic pre-clinically deployable insertable robotic effectors platform (IREP) for single-port access surgery. Automated mock force-controlled ablation, exploration, and knot tightening are evaluated. A user study involving the daVinci Research Kit surgeon console and the IREP as a surgical slave was carried out to compare the performance of users with and without force feedback based on JEFS for force-controlled ablation and knot tightening. Results in automated experiments and a user study of telemanipulated experiments suggest that intrinsic force-sensing can achieve levels of force uncertainty and force regulation errors of the order of 0.2 N. Using JEFS and automated task execution, repeatability, and force regulation accuracy is shown to be comparable to using a commercial force sensor for human-in-the-loop feedback.
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Affiliation(s)
- Rashid Yasin
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Nabil Simaan
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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18
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Impact of catheter-tissue contact force on lesion size during right ventricular outflow tract ablation in a swine model. Chin Med J (Engl) 2020; 133:1680-1687. [PMID: 32496308 PMCID: PMC7401743 DOI: 10.1097/cm9.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The catheter-tissue contact force (CF) is one of the significant determinants of lesion size and thus has a considerable impact on the effectiveness of ablation procedures. This study aimed to evaluate the impact of CF on the lesion size during right ventricular outflow tract (RVOT) ablation in a swine model. Methods Twelve Guangxi Bama miniature male pigs weighing 40 to 50 kg were studied. After general anesthesia, a ThermoCool SmartTouch contact-sensing ablation catheter was introduced to the RVOT via the femoral vein under the guidance of the CARTO 3 system. The local ventricular voltage amplitude and impedance were measured using different CF levels. We randomly divided the animals into the following four groups according to the different CF levels: group A (3–9 g); group B (10–19 g); group C (20–29 g); and group D (30–39 g). Radiofrequency ablations were performed at three points in the free wall and septum of the RVOT in power control mode at 30 W for 30 s while maintaining the saline irrigation rate at 17 mL/min. At the end of the procedures, the maximum depth, surface diameter, and lesion volume were measured and recorded. A linear regression analysis was performed to determine the relationship between continuous variables. Results A total of 72 ablation lesions were created in the RVOT of the 12 Bama pigs. The maximum depth, surface diameter, and volume of the lesions measured were well correlated with the CF (free wall: β = 0.105, β = 0.162, β = 3.355, respectively, P < 0.001; septum: β = 0.093, β = 0.150, β = 3.712, respectively, P < 0.001). The regional ventricular bipolar voltage amplitude, unipolar voltage amplitude, and impedance were weakly positively associated with the CF (β = 0.065, β = 0.125, and β = 1.054, respectively, P < 0.001). There was a significant difference in the incidence of steam pops among groups A, B, C, and D (free wall: F = 7.3, P = 0.032; septum: F = 10.5, P = 0.009); and steam pops occurred only when the CF exceeded 20 g. Trans-mural lesions were observed when the CF exceeded 10 g in the free wall, while the lesions in the septum were non-trans-mural even though the CF reached 30 g. Conclusions CF seems to be a leading predictive factor for the size of formed lesions in RVOT ablation. Maintaining the CF value between 3 and 10 g may be reasonable and effective for creating the necessary lesion size and reducing the risk of complications, such as steam pops and perforations.
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19
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Hao R, Greigarn T, Çavuşoğlu MC. Contact Stability Analysis of Magnetically-Actuated Robotic Catheter Under Surface Motion. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION : ICRA : [PROCEEDINGS]. IEEE INTERNATIONAL CONFERENCE ON ROBOTICS AND AUTOMATION 2020; 2020:4455-4462. [PMID: 34123481 PMCID: PMC8197595 DOI: 10.1109/icra40945.2020.9196951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Contact force quality is one of the most critical factors for safe and effective lesion formation during cardiac ablation. The contact force and contact stability plays important roles in determining the lesion size and creating a gap-free lesion. In this paper, the contact stability of a novel magnetic resonance imaging (MRI)-actuated robotic catheter under tissue surface motion is studied. The robotic catheter is modeled using a pseudo-rigid-body model, and the contact model under surface constraint is provided. Two contact force control schemes to improve the contact stability of the catheter under heart surface motions are proposed and their performance are evaluated in simulation.
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Affiliation(s)
- Ran Hao
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH
| | - Tipakorn Greigarn
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH
| | - M Cenk Çavuşoğlu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH
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20
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Hooshiar A, Najarian S, Dargahi J. Haptic Telerobotic Cardiovascular Intervention: A Review of Approaches, Methods, and Future Perspectives. IEEE Rev Biomed Eng 2019; 13:32-50. [PMID: 30946677 DOI: 10.1109/rbme.2019.2907458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac diseases are recognized as the leading cause of mortality, hospitalization, and medical prescription globally. The gold standard for the treatment of coronary artery stenosis is the percutaneous cardiac intervention that is performed under live X-ray imaging. Substantial clinical evidence shows that the surgeon and staff are prone to serious health problems due to X-ray exposure and occupational hazards. Telerobotic vascular intervention systems with a master-slave architecture reduced the X-ray exposure and enhanced the clinical outcomes; however, the loss of haptic feedback during surgery has been the main limitation of such systems. This paper is a review of the state of the art for haptic telerobotic cardiovascular interventions. A survey on the literature published between 2000 and 2019 was performed. Results of the survey were screened based on their relevance to this paper. Also, the leading research disciplines were identified based on the results of the survey. Furthermore, different approaches for sensor-based and model-based haptic telerobotic cardiovascular intervention, haptic rendering and actuation, and the pertinent methods were critically reviewed and compared. In the end, the current limitations of the state of the art, unexplored research areas as well as the future perspective of the research on this technology were laid out.
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21
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Ershad F, Sim K, Thukral A, Zhang YS, Yu C. Invited Article: Emerging soft bioelectronics for cardiac health diagnosis and treatment. APL MATERIALS 2019; 7:031301. [PMID: 32551188 PMCID: PMC7187908 DOI: 10.1063/1.5060270] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/19/2018] [Indexed: 05/05/2023]
Abstract
Cardiovascular diseases are among the leading causes of death worldwide. Conventional technologies for diagnosing and treating lack the compliance and comfort necessary for those living with life-threatening conditions. Soft electronics presents a promising outlet for conformal, flexible, and stretchable devices that can overcome the mechanical mismatch that is often associated with conventional technologies. Here, we review the various methods in which electronics have been made flexible and stretchable, to better interface with the human body, both externally with the skin and internally with the outer surface of the heart. Then, we review soft, wearable, noninvasive heart monitors designed to be attached to the chest or other parts of the body for mechano-acoustic and electrophysiological sensing. A common method of treatment for various abnormal heart rhythms involves catheter ablation procedures and we review the current soft bioelectronics that can be placed on the balloon or head of the catheter. Cardiac mapping is integral to determine the state of the heart; we discuss the various parameters for sensing aside from electrophysiological sensing, such as temperature, pH, strain, and tactile sensing. Finally, we review the soft devices that harvest energy from the natural and spontaneous beating of the heart by converting its mechanical motion into electrical energy to power implants.
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Affiliation(s)
- Faheem Ershad
- Department of Biomedical Engineering, University
of Houston, Houston, Texas 77204, USA
| | - Kyoseung Sim
- Department of Mechanical Engineering, University
of Houston, Houston, Texas 77204, USA
| | - Anish Thukral
- Materials Science and Engineering Program,
University of Houston, Houston, Texas 77204, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of
Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge,
Massachusetts 02139, USA
- Authors to whom correspondence should be addressed:
and
| | - Cunjiang Yu
- Authors to whom correspondence should be addressed:
and
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22
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Santoro F, Metzner A, Brunetti ND, Heeger CH, Mathew S, Reissmann B, Lemeš C, Maurer T, Fink T, Rottner L, Inaba O, Kuck KH, Ouyang F, Rillig A. Left atrial anterior line ablation using ablation index and inter-lesion distance measurement. Clin Res Cardiol 2019; 108:1009-1016. [DOI: 10.1007/s00392-019-01428-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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23
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Association between the use of contact force-sensing catheters and cardiac tamponade in atrial fibrillation ablation. J Interv Card Electrophysiol 2019; 55:137-143. [PMID: 30712075 PMCID: PMC6660577 DOI: 10.1007/s10840-019-00516-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/15/2019] [Indexed: 11/05/2022]
Abstract
Introduction Cardiac tamponade is a rare but life-threatening complication during atrial fibrillation (AF) catheter ablation. Contact force (CF)–sensing catheters improve ablation effectiveness. However, the impact of the application of CF-sensing catheters on the occurrence of cardiac tamponade remains unclear. The aim of this study is to evaluate the “real-world” impact of CF-sensing catheters on cardiac tamponade during AF ablation in an experienced medical center. Methods and results This was a retrospective study of consecutive de novo AF ablation procedures at Beijing Anzhen Hospital between 2013 and 2016. The ablation procedure was divided into a CF group and a non-CF group. Logistic regression analysis was used to evaluate the association between the use of CF-sensing catheters and the risk of cardiac tamponade. A total of 5313 patients with AF were involved in this study. The incidence of cardiac tamponade in the CF group was significantly higher than that in the non-CF group (1.07% vs. 0.44%, P = 0.009). Of the cardiac tamponade cases in the non-CF group, 45.45% were delayed compared with 10% in the CF group (P = 0.011). Multivariate logistic regression analysis showed that CF-sensing catheters increased the risk of cardiac tamponade (OR = 2.34, 95% CI = 1.17–4.26, P = 0.015). Stratified analysis revealed patients with a smaller left atrium dimension, lower ejection fraction, longer procedure duration, or longer ablation duration had a greater risk of cardiac tamponade during ablation with CF-sensing catheters. Conclusions CF-sensing catheters increase the risk of cardiac tamponade during AF ablation. Electronic supplementary material The online version of this article (10.1007/s10840-019-00516-z) contains supplementary material, which is available to authorized users.
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Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kanamori N, Kato T, Sakagami S, Saeki T, Kato C, Kawai K, Chikata A, Takashima SI, Murai H, Usui S, Furusho H, Kaneko S, Takamura M. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol 2018; 29:1616-1623. [PMID: 30176083 DOI: 10.1111/jce.13727] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/04/2018] [Accepted: 08/23/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A novel real-time lesion size index (LSI) that incorporates contact force (CF), time, and power has been developed for safe and effective catheter ablation. The optimal LSI was evaluated to eliminate gap formation during pulmonary vein isolation (PVI). METHODS AND RESULTS Consecutive patients were enrolled, who underwent their first PVI using a fiber-optic CF-sensing catheter for atrial fibrillation between December 2016 and October 2017. The CF parameters, force-time integral (FTI), and LSI for 3095 ablation points in 34 patients were evaluated. The FTI and LSI in the lesions with gaps or dormant conduction (gaps/DC) were significantly lower than those in the lesion without gaps/DC (FTI: 140.5 ± 54.5 and 232.4 ± 121.4 g s, P < 0.0001; LSI: 4.0 ± 0.6 and 4.7 ± 0.9, P < 0.0001, respectively). On receiver operating characteristic curve analysis, the optimal LSI threshold was 4.05 (sensitivity, 63.4%; specificity, 76.3%). The LSI of <5.25 predicted a gap or DC with a high sensitivity (sensitivity, 97.6%; specificity, 25.7%). In the posterior wall, which was 37% thinner than the nonposterior wall, a lower LSI of <3.95 showed a relatively high sensitivity (92.3%) and specificity (65.6%). CONCLUSIONS The LSI can be used to predict gaps/DC during the PVI procedure. An LSI of 5.2 may be a suitable target for effective lesion formation. An LSI of 4.0 may be acceptable in the posterior wall, especially in areas adjacent to the esophagus.
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Affiliation(s)
- Naomi Kanamori
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan.,Department of Cardiovascular Medicine, Kanazawa Medical Center, National Hospital Organization, Kanazawa, Japan
| | - Takeshi Kato
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Sakagami
- Department of Cardiovascular Medicine, Kanazawa Medical Center, National Hospital Organization, Kanazawa, Japan
| | - Takahiro Saeki
- Department of Cardiovascular Medicine, Kanazawa Medical Center, National Hospital Organization, Kanazawa, Japan
| | - Chieko Kato
- Department of Cardiovascular Medicine, Kanazawa Medical Center, National Hospital Organization, Kanazawa, Japan
| | - Keiichi Kawai
- Department of Radiology, Kanazawa Medical Center, National Hospital Organization, Kanazawa, Japan
| | - Akio Chikata
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shin-Ichiro Takashima
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hisayoshi Murai
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Soichiro Usui
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Furusho
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Shuichi Kaneko
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masayuki Takamura
- Department of System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
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Miyamoto K, Matsuyama T, Noda T, Ishibashi‐Ueda H, Kusano K. Pathology after a combination of sequential and simultaneous unipolar radiofrequency ablation of ventricular tachycardia in a postmortem heart with cardiac sarcoidosis. Clin Case Rep 2018; 6:1219-1224. [PMID: 29988673 PMCID: PMC6028406 DOI: 10.1002/ccr3.1577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/09/2018] [Accepted: 04/15/2018] [Indexed: 11/12/2022] Open
Abstract
This report shows a postmortem examination of a heart performed in a patient with cardiac sarcoidosis undergoing a sequential and simultaneous unipolar radiofrequency ablation. A combination of a sequential and simultaneous unipolar radiofrequency ablation might be useful for creating transmural ablation lesions on the interventricular septum in patients with cardiac sarcoidosis.
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Affiliation(s)
- Koji Miyamoto
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Taka‐aki Matsuyama
- Department of PathologyNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Takashi Noda
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | | | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
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Levy MR, Merchant FM, Langberg JJ, Delurgio DB. Use of microelectrode near-field signals to determine catheter contact. J Arrhythm 2018; 34:23-29. [PMID: 29721110 PMCID: PMC5828270 DOI: 10.1002/joa3.12006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background The utility of standard distal bipolar electrograms (sEGMs) for assessing catheter‐tissue contact may be obscured by the presence of far‐field signals. Microelectrode electrograms (mEGMs) may overcome this limitation. Methods We compared 5 mEGM characteristics (amplitude, frequency content, temporal signal variability, presence of injury current, and amplitude differential between bipoles) with the sEGM for determining tissue contact in 20 patients undergoing ablation of typical atrial flutter. Visualization of catheter‐tissue contact by intracardiac echocardiography (ICE) served as the gold standard for assessing contact. Correlation between electrograms and ICE‐verified contact level was reported as percent concordance. Results Three of 5 mEGM characteristics demonstrated significantly better concordance with ICE‐verified contact level than the sEGM (52% concordance with ICE): mEGM frequency content (59% concordance with ICE, P < .001 for comparison with sEGM); mEGM amplitude (concordance 59%, P < .001); and mEGM presence of injury current (56% concordance, P = .001). Concordance of amplitude differential between mEGM bipoles with ICE (49%) was not significantly different than the sEGM (P = .638) whereas mEGM temporal variability (39%) was significantly worse than the sEGM. Using a median of all 5 mEGM characteristics provided additive information (concordance with ICE 64%) and was significantly better than all of the individual mEGM characteristics except frequency content (P = .976). Conclusion Microelectrode EGMs (in particular frequency content, amplitude, and presence of injury current) can improve real‐time assessment of catheter contact compared to the use of standard bipolar EGMs. Broader use of mEGMs may enhance ablation efficacy.
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Affiliation(s)
- Mathew R Levy
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - Faisal M Merchant
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - Jonathan J Langberg
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
| | - David B Delurgio
- Division of Cardiology Section of Cardiac Electrophysiology Emory University School of Medicine Atlanta GA USA
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Whitaker J, Fish J, Harrison J, Chubb H, Williams SE, Fastl T, Corrado C, Van Zaen J, Gibbs J, O’Neill L, Mukherjee R, Rittey D, Thorsten J, Donskoy E, Sohal M, Rajani R, Niederer S, Wright M, O’Neill MD. Lesion Index–Guided Ablation Facilitates Continuous, Transmural, and Durable Lesions in a Porcine Recovery Model. Circ Arrhythm Electrophysiol 2018; 11:e005892. [DOI: 10.1161/circep.117.005892] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Jeffrey Fish
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Thomas Fastl
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Jérôme Van Zaen
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Jennifer Gibbs
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Louisa O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Rahul Mukherjee
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Dianna Rittey
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Jason Thorsten
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Elina Donskoy
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Manav Sohal
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Steve Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
| | - Mark D. O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (J.W., J.H., H.C., S.E.W., T.F., C.C., L.O., R.M., M.S., R.R., S.N., M.W., M.O.N.). Abbott, St. Paul, MN (J.F., J.V.Z., J.G., D.R.). Scientific Solutions LLC, Minneapolis, MN (J.T.). Pathology Consultant Services, Hartford, CT (E.D.)
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 727] [Impact Index Per Article: 121.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Makimoto H, Metzner A, Tilz RR, Lin T, Heeger CH, Rillig A, Mathew S, Lemeš C, Wissner E, Kuck KH, Ouyang F. Higher contact force, energy setting, and impedance rise during radiofrequency ablation predicts charring: New insights from contact force-guided in vivo
ablation. J Cardiovasc Electrophysiol 2017; 29:227-235. [DOI: 10.1111/jce.13383] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/22/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Hisaki Makimoto
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Andreas Metzner
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | | | - Tina Lin
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | | | - Andreas Rillig
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Shibu Mathew
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Christine Lemeš
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Erik Wissner
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Karl-Heinz Kuck
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
| | - Feifan Ouyang
- Department of Cardiology; Asklepios Klinik St. Georg; Hamburg Germany
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1415] [Impact Index Per Article: 202.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Zhang JQ, Yu RH, Liang JB, Long DY, Sang CH, Ma CS, Dong JZ. Reconstruction left atrium and isolation pulmonary veins of paroxysmal atrial fibrillation using single contact force catheter with zero x-ray exposure: A CONSORT Study. Medicine (Baltimore) 2017; 96:e7726. [PMID: 29019873 PMCID: PMC5662296 DOI: 10.1097/md.0000000000007726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Conventional ablation of paroxysmal atrial fibrillation (PAF) is associated with radiation risks for patients and laboratory staff. Three-dimensional (3D) mapping system capable of showing contact force (CF) and direction of catheter tip may compensate for nonfluoroscopic safety issues. OBJECTIVE The aim of this study was to investigate the feasibility of zero x-ray exposure during reconstruction left atrium (LA) and ablation. METHODS Single, CF catheter, and 3D mapping system were used to reconstruct LA and isolate pulmonary veins (PV) in all patients. The patients were randomly divided into 2 groups after LA angiography. In group 1, reconstruction LA and isolation PV was performed with the help of 3D system (without x-ray), whereas in group 2, x-ray and 3D system were utilized to reconstruct LA and ablate PV antrum. After ablation, Lasso catheter was used to confirm the PV isolation. All patients were followed up to 12 months. RESULTS A total of 342 PAF patients were continuously enrolled. The basic clinical characteristics between the 2 groups had no significant difference. Parameters related to the procedure, average procedure time, ablation procedure time, average contact force (CF) applied, the percentage of time within CF settings, and average power applied during radiofrequency application showed no significant difference between the 2 groups. In group 1, the average fluoroscopy time before LA reconstruction was similar to that in group 2 (2.8 ± 0.4 vs. 2.4 ± 0.6 minutes, P = .75). The average fluoroscopy time during ablation was significantly lower than that in group 2 (0 vs. 7.6 ± 1.3 minutes, P < .001). The total x-ray exposure dose of the procedure in group 1 was significantly lower than that in group 2 (19.6 ± 9.4 vs. 128.7 ± 62.5 mGy, respectively, P < .001). Kaplan-Meier analysis indicated that there were no statistical differences in the probability of freedom from atrial arrhythmia (AF/AFL/AT) recurrence at 12 months between group 1 and group 2 (P = .152). The success rate after a single ablation procedure and without drugs (Class I/III AAD) at 12 months was not significantly different between the 2 groups (67.6%, 95% confidence interval [CI]: 62%-79.5% in group 1 and 68.9%, 95% CI: 63%-80.7% in group 2, P = .207). Procedural-related adverse events showed no significant different incidence between group 1 and group 2. A multivariate logistic regression analysis of risk factors was performed to evaluate the effectiveness outcome, which demonstrated that the percentage of CF (within the investigator-selected work ranges) during therapy was significantly associated with positive outcomes (odds ratio: 3.68; 95% CI: 1.65-10.6, P = .008), whereas the LA dimension was negatively associated with effectiveness outcomes (odds ratio: 0.72; 95% CI: 0.52-0.84, P = .016). CONCLUSIONS Reconstruction LA and isolation PV ablation using single CF-assisted catheter without x-ray exposure was both safe and effective. CF was positively associated with effective outcomes and LA dimensions negatively with effective ones.
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Affiliation(s)
- Jian Qiang Zhang
- Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai Beijing Anzhen Hospital, Capital Medical University, Beijing Juxian People Hospital, Shandong Province 276500,China
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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34
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Rillig A, Schmidt B, Di Biase L, Lin T, Scholz L, Heeger CH, Metzner A, Steven D, Wohlmuth P, Willems S, Trivedi C, Galllinghouse JG, Natale A, Ouyang F, Kuck KH, Tilz RR. Manual Versus Robotic Catheter Ablation for the Treatment of Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:875-883. [DOI: 10.1016/j.jacep.2017.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
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35
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Wang Y, Guo S, Li Y, Tamiya T, Song Y. Design and evaluation of safety operation VR training system for robotic catheter surgery. Med Biol Eng Comput 2017; 56:25-35. [PMID: 28667589 DOI: 10.1007/s11517-017-1666-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/10/2017] [Indexed: 12/26/2022]
Abstract
A number of remote robotic catheter systems have been developed to protect physicians from X-ray exposure in endovascular surgery. However, the teleoperation prevents the physicians sensing the force directly which may easily result in healthy vessels injured. To realize the safe operation, a tissue protection-based VR training system has been developed in this paper to prevent collateral damage by collision. The integrated VR simulator cannot only remind the novice possible collisions by visual signs, but also cooperate with the newly designed tissue protection mechanism to remit collision trauma beforehand. Such mechanism exploits the diameter variable pulley in order to implement the safe interaction between catheter and vasculature. To testify the effectiveness of the tissue protection in training system, we invited four non-medical students to participate the successive 5 days training session. The evaluation results show that the average impingement distance (representing tissue damage) to vascular wall has been reduced to 0.6 mm, and the collision frequency is greatly decreased which implies the realization of relative safe catheterization.
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Affiliation(s)
- Yu Wang
- School of Electronics and Information Engineering, Southwest Petroleum University, Chengdu, Sichuan, China.
| | - Shuxiang Guo
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information, School of Life Science, Beijing Institute of Technology, Haidian District, Beijing, China.,Intelligent Mechanical Systems, Engineering Department, Kagawa University, Takamatsu, Kagawa, Japan
| | - Yaxin Li
- School of Electronics and Information Engineering, Southwest Petroleum University, Chengdu, Sichuan, China
| | - Takashi Tamiya
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Yu Song
- Graduate School of Engineering, Kagawa University, Takamatsu, Kagawa, Japan
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36
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Back J, Lindenroth L, Rhode K, Liu H. Model-Free Position Control for Cardiac Ablation Catheter Steering Using Electromagnetic Position Tracking and Tension Feedback. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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37
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Kang SJ, Pak JJ. A review: flexible, stretchable multifunctional sensors and actuators for heart arrhythmia therapy. MICRO AND NANO SYSTEMS LETTERS 2017. [DOI: 10.1186/s40486-017-0055-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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38
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Liu T, Lombard Poirot N, Greigarn T, Cenk Çavuşoğlu M. Design of a Magnetic Resonance Imaging Guided Magnetically Actuated Steerable Catheter. J Med Device 2017; 11:0210041-2100411. [PMID: 28690711 DOI: 10.1115/1.4036095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/25/2017] [Indexed: 11/08/2022] Open
Abstract
This paper presents design optimization of a magnetic resonance imaging (MRI) actuated steerable catheter for atrial fibrillation ablation in the left atrium. The catheter prototype, built over polymer tubing, is embedded with current-carrying electromagnetic coils. The prototype can be deflected to a desired location by controlling the currents passing through the coils. The design objective is to develop a prototype that can successfully accomplish the ablation task. To complete the tasks, the catheter needs to be capable of reaching a set of desired targets selected by a physician on the chamber and keeping a stable contact with the chamber surface. The design process is based on the maximization of the steering performance of the catheter by evaluating its workspace in free space. The selected design is validated by performing a simulation of an ablation intervention on a virtual model of the left atrium with a real atrium geometry. This validation shows that the prototype can reach every target required by the ablation intervention and provide an appropriate contact force against the chamber.
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Affiliation(s)
- Taoming Liu
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH 44106 e-mail:
| | - Nate Lombard Poirot
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH 44106 e-mail:
| | - Tipakorn Greigarn
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH 44106 e-mail:
| | - M Cenk Çavuşoğlu
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH 44106 e-mail:
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39
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Relationship between left atrium catheter contact force and pacing threshold. J Interv Card Electrophysiol 2017; 49:147-155. [DOI: 10.1007/s10840-017-0253-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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40
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Aagaard P, Briceno D, Csanadi Z, Mohanty S, Gianni C, Trivedi C, Nagy-Baló E, Danik S, Barrett C, Santoro F, Burkhardt JD, Sanchez J, Natale A, Di Biase L. Atrial Fibrillation Ablation and Stroke. Cardiol Clin 2017; 34:307-16. [PMID: 27150179 DOI: 10.1016/j.ccl.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Catheter ablation has become a widely available and accepted treatment to restore sinus rhythm in atrial fibrillation patients who fail antiarrhythmic drug therapy. Although generally safe, the procedure carries a non-negligible risk of complications, including periprocedural cerebral insults. Uninterrupted anticoagulation, maintenance of an adequate ACT during the procedure, and measures to avoid and detect thrombus build-up on sheaths and atheters during the procedure, appears useful to reduce the risk of embolic events. This is a review of the incidence, mechanisms, impact, and methods to reduce catheter ablation related cerebral insults.
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Affiliation(s)
- Philip Aagaard
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA
| | - David Briceno
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA
| | - Zoltan Csanadi
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary
| | - Sanghamitra Mohanty
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Edina Nagy-Baló
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary
| | - Stephan Danik
- The Al-Sabah Arrhythmia Institute at Mount Sinai St. Luke, New York, NY, USA
| | - Conor Barrett
- The Al-Sabah Arrhythmia Institute at Mount Sinai St. Luke, New York, NY, USA
| | | | - J David Burkhardt
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Javier Sanchez
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Andrea Natale
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; CaseWestern Reserve University, Cleveland, OH, USA; EP Services, California Pacific Medical Center, San Francisco, CA, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA.
| | - Luigi Di Biase
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy; Department of Biomedical Engineering, University of Texas, Austin, TX, USA.
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41
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Chinushi M, Saitoh O, Watanabe J, Sugai A, Suzuki K, Hosaka Y, Furushima H. Electrode Contact Force-Controlled Bipolar Radiofrequency Ablation: Different Effects on Lesion Size between Dual- and Single-Bath Preparations. Pacing Clin Electrophysiol 2017; 40:223-231. [PMID: 27943352 DOI: 10.1111/pace.12993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND During bipolar (BIP) radiofrequency (RF) ablation using two catheters in humans, each catheter is placed in separate cardiac chambers or spaces. We developed a contact force-controlled experimental preparation, and compared measurements made with two catheters placed in a single bath (SB), versus each catheter placed in separate baths, in order to assess the preparation-dependent differences in the results of BIP-RF ablation. METHODS In the SB experiments, a porcine heart was placed in the center of the bath, while in the dual-bath (DB) experiments, it was placed between two half baths communicating through windows. RESULTS The initial impedance was greatest (110.5 ± 7.2 Ω) with the BIP-DB, followed by the BIP-SB (92.0 ± 5.6 Ω) and the unipolar (UNIP) DB (84.9 ± 4.7 Ω) configurations. During 50-W ablation for 60 seconds at a 20-g contact force, the root mean square voltage was 75.7 ± 2.5 V in the BIP-DB, 68.0 ± 2.1 V in the BIP-SB, and 66.8 ± 2.0 V in the UNIP-DB. The mean surface lesion diameters were similar among the three configurations. However, the endocardial lesion depth was 5.60 ± 0.56 mm with the BIP-DB, 4.71 ± 0.64 mm with the BIP-SB, and 4.24 ± 0.58 mm with the UNIP-DB configuration. On average, the endocardial lesions were significantly deeper than the epicardial ones. CONCLUSIONS BIP ablation created much deeper lesions as compared to UNIP ablation. Lesion depth could be different depending on experimental preparation, and contact force-controlled DB preparation may be a much more appropriate model for studying the effects of BIP ablation.
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Affiliation(s)
- Masaomi Chinushi
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Osamu Saitoh
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Junya Watanabe
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Ayari Sugai
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Katsuya Suzuki
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Yukio Hosaka
- Cardiology Department, Niigata City General Hospital, Niigata, Japan
| | - Hiroshi Furushima
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
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42
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Pandya HJ, Sheng J, Desai JP. MEMS-Based Flexible Force Sensor for Tri-Axial Catheter Contact Force Measurement. JOURNAL OF MICROELECTROMECHANICAL SYSTEMS : A JOINT IEEE AND ASME PUBLICATION ON MICROSTRUCTURES, MICROACTUATORS, MICROSENSORS, AND MICROSYSTEMS 2017; 26:264-272. [PMID: 28190945 PMCID: PMC5295839 DOI: 10.1109/jmems.2016.2636018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Atrial fibrillation (AFib) is a significant healthcare problem caused by the uneven and rapid discharge of electrical signals from pulmonary veins (PVs). The technique of radiofrequency (RF) ablation can block these abnormal electrical signals by ablating myocardial sleeves inside PVs. Catheter contact force measurement during RF ablation can reduce the rate of AFib recurrence, since it helps to determine effective contact of the catheter with the tissue, thereby resulting in effective power delivery for ablation. This paper presents the development of a three-dimensional (3D) force sensor to provide the real-time measurement of tri-axial catheter contact force. The 3D force sensor consists of a plastic cubic bead and five flexible force sensors. Each flexible force sensor was made of a PEDOT:PSS strain gauge and a PDMS bump on a flexible PDMS substrate. Calibration results show that the fabricated sensor has a linear response in the force range required for RF ablation. To evaluate its working performance, the fabricated sensor was pressed against gelatin tissue by a micromanipulator and also integrated on a catheter tip to test it within deionized water flow. Both experiments simulated the ventricular environment and proved the validity of applying the 3D force sensor in RF ablation.
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Affiliation(s)
- Hardik J Pandya
- Department of Medicine in the Brigham and Womens Hospital - Harvard Medical School, Boston, MA 02115, USA
| | - Jun Sheng
- Medical Robotics and Automation Laboratory (RoboMed) in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Jaydev P Desai
- Medical Robotics and Automation Laboratory (RoboMed) in the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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43
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Aagaard P, Natale A, Briceno D, Nakagawa H, Mohanty S, Gianni C, Burkhardt JD, DI Biase L. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S38-44. [PMID: 26969222 DOI: 10.1111/jce.12938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.
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Affiliation(s)
- Philip Aagaard
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy.,Division of Cardiology, Stanford University, Stanford, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA.,EP Services, California Pacific Medical Center, San Francisco, California, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Dell Medical School, University of Texas, Austin, Texas, USA
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Luigi DI Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
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44
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Ullah W, Schilling RJ, Wong T. Contact Force and Atrial Fibrillation Ablation. J Atr Fibrillation 2016; 8:1282. [PMID: 27909471 DOI: 10.4022/jafib.1282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022]
Abstract
Catheters able to measure the force and vector of contact between the catheter tip and myocardium are now available. Pre-clinical work has established that the degree of contact between the radiofrequency ablation catheter and myocardium correlates with the size of the delivered lesion. Excess contact is associated with steam pops and perforation. Catheter contact varies within the left atrium secondary to factors including respiration, location, atrial rhythm and the trans-septal catheter delivery technology used. Compared with procedures performed without contact force (CF)-sensing, the use of this technology has, in some studies, been found to improve complication rates, procedure and fluoroscopy times, and success rates. However, for each of these parameters there are also studies suggesting a lack of difference from the availability of CF data. Nevertheless, CF-sensing technology has been adopted as a standard of care in many institutions. It is likely that use of CF-sensing technology will allow for the optimization of each individual radiofrequency application to maximize efficacy and procedural safety. Recent work has attempted to define what these optimal targets should be, and approaches to do this include assessing for sites of pulmonary vein reconnection after ablation, or comparing the impedance response to ablation. Based on such work, it is apparent that factors including mean CF, force time integral (the area under the force-time curve) and contact stability are important determinants of ablation efficacy. Multicenter prospective randomized data are lacking in this field and required to define the CF parameters required to produce optimal ablation.
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Affiliation(s)
- W Ullah
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - R J Schilling
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - T Wong
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Gelman D, Skanes AC, Tavallaei MA, Drangova M. Design and Evaluation of a Catheter Contact-Force Controller for Cardiac Ablation Therapy. IEEE Trans Biomed Eng 2016; 63:2301-2307. [DOI: 10.1109/tbme.2016.2525929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
PURPOSE To test and validate magnetic resonance imaging (MRI) sequences for peripheral artery lesion characterization and relate the MRI characteristics to the amount of force required for a guidewire to puncture peripheral chronic total occlusions (CTOs) as a surrogate for immediate failure of endovascular therapy. METHODS Diseased superficial femoral, popliteal, and tibial artery segments containing 55 atherosclerotic lesions were excised from the amputated limbs of 7 patients with critical limb ischemia. The lesions were imaged at high resolution (75 μm3 voxels) with T2-weighted (T2W) and ultrashort echo time (UTE) sequences on a 7-T MR scanner. The MR images (n=15) were validated with micro-computed tomography and histology. CTOs (n=40) were classified by their MR signal characteristics as "soft" (signals indicating fat, thrombus, microchannels, or loose fibrous tissue), "hard" (collagen and/or speckled calcium signals), or "calcified" (calcified nodule signals). A 2-kg load cell advanced the back end of a 0.035-inch stiff guidewire at a fixed displacement rate (0.05 mm/s) through the CTOs, and the forces required to cross each lesion were measured. RESULTS T2W images showed fat as hyperintense and hardened tissue as hypointense. Calcium and thrombus appeared as a signal void in conventional MRI sequences but were easily identified in UTE images (thrombus was hyperintense and calcium hypointense). MRI accurately differentiated "hard," "soft," and "calcified" CTOs based on associated guidewire puncture force. The guidewire could not enter "calcified" CTOs (n=6) at all. "Hard" CTOs (n=9) required a significantly higher (p<0.001) puncture force of 1.71±0.51 N vs 0.43±0.36 N for "soft" CTOs (n=25). CONCLUSION MRI characteristics of PAD lesions correlate with guidewire puncture forces, an important aspect of crossability. Future work will determine if clinical MR scanners can be used to predict success in peripheral vascular interventions.
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Affiliation(s)
- Trisha Roy
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Division of Vascular Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Garry Liu
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Noor Shaikh
- 4 Division of Engineering Science, University of Toronto, Ontario, Canada
| | - Andrew D Dueck
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Division of Vascular Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Graham A Wright
- 1 Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Department of Medical Biophysics, University of Toronto, Ontario, Canada
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Da Costa A, Guichard JB, Roméyer-Bouchard C, Gerbay A, Isaaz K. Robotic magnetic navigation for ablation of human arrhythmias. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:331-339. [PMID: 27698569 PMCID: PMC5034914 DOI: 10.2147/mder.s96167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency treatment represents the first choice of treatment for arrhythmias, in particular complex arrhythmias and especially atrial fibrillation, due to the greater benefit/risk ratio compared to antiarrhythmic drugs. However, complex arrhythmias such as atrial fibrillation require long procedures with additional risks such as X-ray exposure or serious complications such as tamponade. Given this context, the treatment of arrhythmias using robotic magnetic navigation entails a technique well suited to complex arrhythmias on account of its efficacy, reliability, significant reduction in X-ray exposure for both patient and operator, as well as a very low risk of perforation. As ongoing developments will likely improve results and procedure times, this technology will become one of the most modern technologies for treating arrhythmias. Based on the literature, this review summarizes the advantages and limitations of robotic magnetic navigation for ablation of human arrhythmias.
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Affiliation(s)
- Antoine Da Costa
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Jean Baptiste Guichard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Cécile Roméyer-Bouchard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Antoine Gerbay
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Karl Isaaz
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
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Chikata A, Kato T, Sakagami S, Kato C, Saeki T, Kawai K, Takashima SI, Murai H, Usui S, Furusho H, Kaneko S, Takamura M. Optimal Force-Time Integral for Pulmonary Vein Isolation According to Anatomical Wall Thickness Under the Ablation Line. J Am Heart Assoc 2016; 5:e003155. [PMID: 27068636 PMCID: PMC4943282 DOI: 10.1161/jaha.115.003155] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Low contact force and force–time integral (FTI) during catheter ablation are associated with ineffective lesion formation, whereas excessively high contact force and FTI may increase the risk of complications. We sought to evaluate the optimal FTI for pulmonary vein (PV) isolation based on atrial wall thickness under the ablation line. Methods and Results Contact force parameters and FTI during anatomical ipsilateral PV isolation for atrial fibrillation and atrial wall thickness were assessed retrospectively in 59 consecutive patients for their first PV isolation procedure. The PV antrum was divided into 8 segments, and the wall thickness of each segment under the ablation line was determined using multidetector computed tomography. The FTI for each ablation point was divided by the wall thickness of the PV antrum segment where each point was located to obtain FTI/wall thickness. In total, 5335 radiofrequency applications were delivered, and 85 gaps in PV isolation ablation lines and 15 dormant conductions induced by adenosine were detected. The gaps or dormant conductions were significantly associated with low contact force, radiofrequency duration, FTI, and FTI/wall thickness. Among them, FTI/wall thickness had the best prediction value for gaps or dormant conductions by receiver operating characteristic curve analysis. FTI/wall thickness of <76.4 gram‐seconds per millimeter (gs/mm) predicted gaps or dormant conductions with sensitivity (88.0%) and specificity (83.6%), and FTI/wall thickness of <101.1 gs/mm was highly predictive (sensitivity 97.0%; specificity 69.6%). Conclusions FTI/wall thickness is a strong predictor of gap and dormant conduction formation in PV isolation. An FTI/wall thickness ≈100 gs/mm could be a suitable target for effective ablation.
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Affiliation(s)
- Akio Chikata
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Takeshi Kato
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Satoru Sakagami
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Chieko Kato
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Takahiro Saeki
- Department of Cardiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Keiichi Kawai
- Department of Radiology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Shin-Ichiro Takashima
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hisayoshi Murai
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Soichiro Usui
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Furusho
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Shuichi Kaneko
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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de Vries LJ, Szili-Torok T. Optimizing contact force during ablation of atrial fibrillation: available technologies and a look to the future. Future Cardiol 2016; 12:197-207. [DOI: 10.2217/fca.15.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In a select atrial fibrillation population, catheter ablation is considered first-line therapy. Prevention of early reconnection of the isolated pulmonary veins is an important goal for a successful treatment. Here, adequate catheter–tissue contact is crucial. One of the most promising new advances, therefore, is contact force (CF) sensing technology. The aim of this review is to provide an overview of innovations regarding catheter ablation of atrial fibrillation with a special focus on CF optimization. Both experimental and human studies show how CF sensing catheters lead to a reduction of fluoroscopy time, increased procedural safety and a better clinical outcome. Possible future developments include new parameters combining real-time ablation data, direct visualization of lesion formation and incorporation of robotics.
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Affiliation(s)
- Lennart J de Vries
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Dello Russo A, Fassini G, Conti S, Casella M, Di Monaco A, Russo E, Riva S, Moltrasio M, Tundo F, De Martino G, Gallinghouse GJ, Di Biase L, Natale A, Tondo C. Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study. J Interv Card Electrophysiol 2016; 46:97-103. [DOI: 10.1007/s10840-016-0102-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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