1
|
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.
Collapse
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
| |
Collapse
|
2
|
Pešl M, Kulík T, Ostřížek T, Horváth V, Souček F, Melajová K, Doležalová K, Žáková D, Jadczyk T, Lehar F, Jež J, Stárek Z. Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation. VNITRNI LEKARSTVI 2022; 68:20-26. [PMID: 36283813 DOI: 10.36290/vnl.2022.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center. Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly dilated left atrium 57.9 ± 11.0mm in the period September 2016-March 2019. RESULTS The median duration of the procedure was 232 minutes and the median duration of hospitalization was 10 days. At discharge, 52 patients (100%) had sinus rhythm. 48 of 52 patients (92.3%) had a 6-month follow-up. 41 of 48 (85.4%) and 38 of 44 (86.4%) of patients were AF free at 3-month and 6-month follow-up, respectively. Acute complications were: one left atrial perforation resolved successfully by suture and one transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae. CONCLUSION Hybrid thoracoscopic-catheter ablation performed during one procedure is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation.
Collapse
|
3
|
Santoro A, Baiocchi C, Sisti N, Zacà V, Pondrelli CR, Falciani F, Lamberti F. Catheter inversion during cavotricuspid isthmus catheter ablation: The new shaft visualization catheter reduces fluoroscopy use. J Arrhythm 2021; 37:1311-1317. [PMID: 34621430 PMCID: PMC8485825 DOI: 10.1002/joa3.12596] [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: 11/30/2020] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022] Open
Abstract
AIMS Catheter ablation (CA) is the choice therapy of cavotricuspid isthmus (CTI) atrial flutter. The aim of this study was to describe our approach to improve the CTI ablation using a zero-fluoroscopy (ZF). The procedural difficulties could be related to anatomical characteristics of the CTI. METHODS One hundred eighty-eight patients that performed CA of CTI were retrospectively and consecutively evaluated between 2017 and 2019. The studied population was divided into two groups. Eighty-eight patients who were undergone CA using ablation catheter without shaft visualization catheter (NSV) were Group 1. One hundred patients were undergone CA using ablation catheter with a shaft visualization (SV); they were Group 2. The catheter was looped at the Eustachian ridge after 200 seconds of radiofrequencies (RF) without elimination of local electrogram. RESULTS A conduction line block of CTI was obtained in all patients of Group 2 using a ZF approach. In 16 patients of Group 1, the catheter inversion was obtained using fluoroscopy to avoid damages during its loop. In Group 2, a complete CTI block was obtained with a catheter inversion approach in ten patients without fluoroscopy, visualizing the shaft and the tip of the ablation catheter on the electroanatomic (EAM) map. In the overall population studied the use of SV had a linear correlation with the ZF approach (r = .629; P < .001). The duration of RF was lower in Group 2 than in Group 1 (Group 1: 27.8 ± 6.3 vs Group 2: 15.6 ± 7.2 minutes; P < .01). The procedure time between two groups was lower in Group 2 than in Group 1 (Group 1: 58.4 ± 22.4 vs Group 2: 42.2 ± 15.7 minutes; P < .01). No differences between two groups were documented regarding success and complications. CONCLUSIONS The visualization of the shaft's catheter on the EAM permitted the catheter inversion safely in order to overcome some complex CTI anatomy and obtain bidirectional block. The SV reduced procedure time, RF applications and fluoroscopy exposition during CTI ablation.
Collapse
Affiliation(s)
- Amato Santoro
- Division of Cardiology Azienda Ospedaliera Universitaria Senese Siena Italy
| | - Claudia Baiocchi
- Division of Cardiology Azienda Ospedaliera Universitaria Senese Siena Italy
| | - Nicolò Sisti
- Division of Cardiology Azienda Ospedaliera Universitaria Senese Siena Italy
| | - Valerio Zacà
- Division of Cardiology Azienda Ospedaliera Universitaria Senese Siena Italy
| | | | | | - Filippo Lamberti
- Division of Medicine Cardiovascular Section San Eugenio Hospital Rome Italy
| |
Collapse
|
4
|
Cho MS, Kim J, Do U, Kim M, Nam GB, Choi KJ, Kim YH. Clinical outcomes after pulmonary vein isolation using an automated tagging module in patients with paroxysmal atrial fibrillation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00021-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
An automated tagging module (VISITAG™; Biosense Webster, Irvine, CA) allows objective demonstration of energy delivery. However, the effect of VISITAG™ on clinical outcomes remains unclear. This study evaluated (1) clinical outcome after AF ablation using VISITAG™ and (2) the prevalence of gaps in the ablation line.
Methods
This retrospective analysis included 157 consecutive patients (mean age, 56.7 years; 73.2% men) with paroxysmal atrial fibrillation who underwent successful PVI between 2013 and 2016. Outcomes after the index procedure were compared between those using the VISITAG™ module (VISITAG group, n = 62) and those not using it (control group, n = 95). The primary outcome was recurrence of AF or atrial tachycardia after a blanking period of 3 months.
Results
The VISITAG group showed significantly shorter overall procedure time (172.2 ± 37.6 min vs. 286.9 ± 66.7 min, P < 0.001), ablation time (49.8 ± 9.7 min vs. 82.8 ± 28.2 min, P < 0.001), and fluoroscopy time (11.8 ± 5.3 min vs. 34.2 ± 30.1 min, P < 0.001) compared with controls. The 1-year recurrence-free survival rate was not statistically different between the groups (70.8% in the VISITAG group vs. 79.2% in the control group, P = 0.189). Gaps in the VISITAG line were common in the both carina and left side pulmonary veins. Patients without gaps (≥ 5 mm) by the criteria emphasizing catheter stability (> 15 s, < 4 mm range, > 60% force over time, > 6 g contact force) showed higher recurrence-free survival rate compared with those with gaps (borderline statistical significance, 91.7% vs. 66.0%, P = 0.094).
Conclusion
Use of the VISITAG™ module significantly reduced procedure, ablation, and fluoroscopic times with a similar AF/AT recurrence rate compared with the conventional ablation. Clinical implications of minimizing gaps along the ablation line should be evaluated further in the future prospective studies.
Collapse
|
5
|
Jez J, Jadczyk T, Lehar F, Pesl M, Kulik T, Belaskova S, Soucek F, Caluori G, Wojakowski W, Starek Z. Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:387-393. [PMID: 31645769 DOI: 10.5507/bp.2019.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF). METHODS 146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up. RESULTS Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm2, P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77). CONCLUSIONS Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.
Collapse
Affiliation(s)
- Jiri Jez
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomasz Jadczyk
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frantisek Lehar
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Pesl
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kulik
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic
| | - Silvie Belaskova
- Biostatistics, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Filip Soucek
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic
| | - Guido Caluori
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,CEITEC, Masaryk University, Brno, Czech Republic
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Zdenek Starek
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
6
|
Hoshiyama T, Fukushima H, Noda K, Oshima S, Ashikaga K, Ikeda T, Sakamoto K, Tsujita K. Effect of Contact Vector Direction on Achieving Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol 2019; 12:e007320. [PMID: 31345094 DOI: 10.1161/circep.119.007320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tadashi Hoshiyama
- Division of Cardiology, Kumamoto Chuo Hospital (T.H., H.F., K.N., S.O.)
| | | | - Katsuo Noda
- Division of Cardiology, Kumamoto Chuo Hospital (T.H., H.F., K.N., S.O.)
| | - Shuichi Oshima
- Division of Cardiology, Kumamoto Chuo Hospital (T.H., H.F., K.N., S.O.)
| | - Keiichi Ashikaga
- Miyazaki Medical Association Hospital Cardiovascular Center (K.A.)
| | - Tokunori Ikeda
- Department of Clinical Investigation, Kumamoto University Hospital (T.I.)
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (K.S., K.T.)
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (K.S., K.T.)
| |
Collapse
|
7
|
Chubb H, Lal K, Kiedrowicz R, Karim R, Williams SE, Harrison J, Whitaker J, Wright M, Razavi R, O’Neill M. The value of ablation parameter indices for predicting mature atrial scar formation in humans: An in vivo assessment using cardiac magnetic resonance imaging. J Cardiovasc Electrophysiol 2018; 30:67-77. [DOI: 10.1111/jce.13754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Kulvinder Lal
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | | | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London; London UK
- Department of Cardiology; St Thomas’ Hospital; London UK
| |
Collapse
|
8
|
Franco E, Rodríguez Muñoz D, Matía R, Hernández-Madrid A, Sánchez Pérez I, Zamorano JL, Moreno J. Contact force-sensing catheters: performance in an ex vivo porcine heart model. J Interv Card Electrophysiol 2018; 53:141-150. [PMID: 30109525 DOI: 10.1007/s10840-018-0435-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/27/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE Contact force (CF) catheters are useful to address proper contact during ablation. However, interactions between the ablation process, or its associated irrigation flow changes, with the CF sensing may translate into unexpected CF value fluctuations. We aimed to test for unintentional CF value variations during radiofrequency applications at a fixed applied force, with two commercially available catheters (TactiCath™ and SmartTouch™), and to evaluate its theoretical clinical significance by correlating CF-derived automatic ablation algorithms (force-time integral and lesion index) and actual lesion size at two standard CF values. METHODS Four series of 20 perpendicular epicardial ablations (20 W, 60 s, 17 ml/min) were performed on porcine left ventricle submerged in 37 °C saline. Catheters were mechanically fixed at a constant position and evaluated at 10 and 20 g. CF values were digitally analysed before each application changing irrigation rate (2-17-30 ml/min), and during ablation. Finally, lesions were quantified. RESULTS Increasing irrigation before ablation led to a slight but significant CF decrease. During ablation, CF showed a reproducible pattern: fast initial decrease, subsequent increase until higher-than-initial values and final plateau phase (CF variation up to 69% at 10 g). CF variability was significantly higher at 10 g and using TactiCath™. There were no major differences in lesion size between catheters at the same initial CF. CF only correlated mildly to lesion measures, and automatic algorithms globally failed to predict lesion size. CONCLUSIONS CF measured values spontaneously vary during ablation following a predictable pattern (initial decrease, subsequent increase and final plateau). This is especially remarkable applying lower CF.
Collapse
Affiliation(s)
- Eduardo Franco
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain.
| | - Daniel Rodríguez Muñoz
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - Roberto Matía
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - Antonio Hernández-Madrid
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | | | - José Luis Zamorano
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - Javier Moreno
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| |
Collapse
|
9
|
Park H, Kim I, Cho Y, Yoon H, Kim H, Nam C, Han S, Hur S, Kim Y, Kim K. Comparison of the efficacy between impedance-guided and contact force-guided atrial fibrillation ablation using an automated annotation system. J Arrhythm 2018; 34:239-246. [PMID: 29951138 PMCID: PMC6010015 DOI: 10.1002/joa3.12054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/07/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study compared the efficacy of catheter ablation of atrial fibrillation (AF) between impedance (IMP)-guided and contact force (CF)-guided annotation using the automated annotation system (VisiTag™). METHODS Fifty patients undergoing pulmonary vein isolation (PVI) for AF were randomized to the IMP-guided or CF-guided groups. The annotation criteria for VisiTag™ were a 10 second minimum ablation time and 2 mm maximum catheter movement range. A minimum CF of 10 g was added to the criteria in the CF-guided group. In the IMP-guided group, a minimum IMP drop of over 5 Ω was added to the criteria. RESULTS The rates of successful PVI after an initial ablation line were higher in the CF-guided group (80% vs 48%, P = .018). Although average CF was similar between two groups, the average force-time integral (FTI) was significantly higher in the CF-guided group (298.3 ± 65. 2 g·s vs 255.1 ± 38.3 g·s, P = .007). The atrial arrhythmia-free survival at 1 year demonstrated no difference between the two groups (84.0% in the IMP-guided group vs 80.0% in the CF-guided group, P = .737). If the use of any antiarrhythmic drug beyond the blanking period was considered as a failure, the clinical success rate at 1 year was 52.0% for the CF-guided group vs 56.0% for the IMP-guided group (P = .813). CONCLUSIONS Atrial fibrillation ablation using an automated annotation system guided by CF improved the success rate of PVI after the initial circumferential ablation. An IMP-guided annotation combined with catheter stability criteria showed similar clinical outcomes as compared to the CF-guided annotation.
Collapse
Affiliation(s)
- Hyoung‐Seob Park
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - In‐Cheol Kim
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Yun‐Kyeong Cho
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Hyuck‐Jun Yoon
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Hyungseop Kim
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Chang‐Wook Nam
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Seongwook Han
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Seung‐Ho Hur
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Yoon‐Nyun Kim
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| | - Kwon‐Bae Kim
- Division of CardiologyDongsan Medical CenterKeimyung UniversityDaeguKorea
| |
Collapse
|
10
|
Borlich M, Iden L, Kuhnhardt K, Paetsch I, Hindricks G, Sommer P. 3D Mapping for PVI- Geometry, Image Integration and Incorporation of Contact Force Into Work Flow. J Atr Fibrillation 2018; 10:1795. [PMID: 29988269 DOI: 10.4022/jafib.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/19/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2022]
Abstract
Catheter ablation of atrial fibrillation has evolved enormously thanks to rapid improvement of modern mapping technologies, progress in catheter development and current possibilities for reduction of radiation exposure. Pulmonary vein isolation is thereby the cornerstone in this interventional treatment. Increased precision of catheter localization by modern three-dimensional mapping systems, faster and better processing of local electrograms and their immediate color-based visualization make it possible to treat even challenging arrhythmias very effectively. The commonly used three-dimensional mapping systems CARTO 3 (Biosense Webster, Irvine, Ca.) and Ensite Precision (St. Jude Medical, St. Paul, Min) differ in construction and principles of the underlying mapping technology. In this review article, we aim to emphasize the most important aspects of possibilities that make both systems so valuable for interventional treatment of atrial fibrillation. We present a modern workflow, that unites three-dimensional LA mapping with collecting relevant local information, image integration for refining the map and beneficial use of contact force based ablation approach.
Collapse
Affiliation(s)
- Martin Borlich
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Leon Iden
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Ingo Paetsch
- Heart Center, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | | | - Philipp Sommer
- Department of Electrophysiology, Heart Center, Leipzig, Germany
| |
Collapse
|
11
|
Linte CA, Camp JJ, Rettmann ME, Haemmerich D, Aktas MK, Huang DT, Packer DL, Holmes DR. Lesion modeling, characterization, and visualization for image-guided cardiac ablation therapy monitoring. J Med Imaging (Bellingham) 2018; 5:021218. [PMID: 29531966 PMCID: PMC5831757 DOI: 10.1117/1.jmi.5.2.021218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
In spite of significant efforts to improve image-guided ablation therapy, a large number of patients undergoing ablation therapy to treat cardiac arrhythmic conditions require repeat procedures. The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation, in turn leading to the arrhythmia recurrence. Ongoing research efforts aim to better characterize and visualize RF delivery to monitor the induced tissue damage during therapy. Here, we propose a method that entails modeling and visualization of the lesions in real-time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression are quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples undergoing ex vivo clinically relevant ablation protocols. The studies demonstrated less than 5°C difference between the model-predicted and experimentally measured end-ablation temperatures. The model predicted lesion patterns were within 0.5 to 1 mm from the observed lesion patterns, suggesting sufficiently accurate modeling of the ablation lesions. Lastly, our proposed method enables therapy delivery feedback with no significant workflow latency. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.
Collapse
Affiliation(s)
- Cristian A. Linte
- Rochester Institute of Technology, Biomedical Engineering and Chester F. Carlson Center for Imaging Science, Rochester, New York, United States
| | - Jon J. Camp
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
| | - Maryam E. Rettmann
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - Dieter Haemmerich
- Medical University of South Carolina, Department of Pediatrics, Charleston, South Carolina, United States
| | - Mehmet K. Aktas
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - David T. Huang
- University of Rochester Medical Center, Division of Cardiology, Rochester, New York, United States
| | - Douglas L. Packer
- Mayo Clinic, Division of Cardiology, Rochester, Minnesota, United States
| | - David R. Holmes
- Mayo Clinic, Biomedical Imaging Resource, Rochester, Minnesota, United States
| |
Collapse
|
12
|
Linte CA, Camp JJ, Rettmann ME, Haemmerich D, Aktas MK, Huang DT, Packer DL, Holmes DR. Technical Note: On Cardiac Ablation Lesion Visualization for Image-guided Therapy Monitoring. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10576:105760N. [PMID: 31213732 PMCID: PMC6581517 DOI: 10.1117/12.2322523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The delivery of insufficient thermal dose is a significant contributor to incomplete tissue ablation and leads to arrhythmia recurrence and a large number of patients requiring repeat procedures. In concert with ongoing research efforts aimed at better characterizing the RF energy delivery, here we propose a method that entails modeling and visualization of the lesions in real time. The described image-based ablation model relies on classical heat transfer principles to estimate tissue temperature in response to the ablation parameters, tissue properties, and duration. The ablation lesion quality, geometry, and overall progression is quantified on a voxel-by-voxel basis according to each voxel's cumulative temperature and time exposure. The model was evaluated both numerically under different parameter conditions, as well as experimentally, using ex vivo bovine tissue samples. This study suggests that the proposed technique provides reasonably accurate and sufficiently fast visualizations of the delivered ablation lesions.
Collapse
Affiliation(s)
- Cristian A. Linte
- Biomedical Engineering and Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester NY USA
- Biomedical Imaging Resource, Mayo Clinic, Rochester MN USA
| | - Jon J. Camp
- Biomedical Imaging Resource, Mayo Clinic, Rochester MN USA
| | | | - Dieter Haemmerich
- Department of Pediatrics, Medical University of South Carolina, Charleston SC USA
| | - Mehmet K. Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester NY USA
| | - David T. Huang
- Division of Cardiology, University of Rochester Medical Center, Rochester NY USA
| | | | | |
Collapse
|
13
|
Keçe F, Zeppenfeld K, Trines SA. The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications. Arrhythm Electrophysiol Rev 2018; 7:169-180. [PMID: 30416730 DOI: 10.15420/aer.2018.7.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The number of patients with atrial fibrillation currently referred for catheter ablation is increasing. However, the number of trained operators and the capacity of many electrophysiology labs are limited. Accordingly, a steeper learning curve and technical advances for efficient and safe ablation are desirable. During the last decades several catheter-based ablation devices have been developed and adapted to improve not only lesion durability, but also safety profiles, to shorten procedure time and to reduce radiation exposure. The goal of this review is to summarise the reported incidence of complications, considering device-related specific aspects for point-by-point, multi-electrode and balloon-based devices for pulmonary vein isolation. Recent technical and procedural developments aimed at reducing procedural risks and complications rates will be reviewed. In addition, the impact of technical advances on procedural outcome, procedural length and radiation exposure will be discussed.
Collapse
Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
| |
Collapse
|
14
|
Two-Year Follow-Up after Contact Force Sensing Radiofrequency Catheter and Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6495753. [PMID: 27314032 PMCID: PMC4893449 DOI: 10.1155/2016/6495753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
Background. There are little comparative data on catheter ablation of paroxysmal atrial fibrillation (AF) using the contact force radiofrequency (CF-RF) catheter versus the second-generation cryoballoon (CB2). Methods and results. This is a single center, retrospective, nonrandomized study of 98 patients with symptomatic, drug-refractory paroxysmal AF who underwent their first PVI ablation using either the CB2 (n = 40) or CF-RF (n = 58). The mean age was 60 years with 63% men, a mean LA size of 42 mm. The procedure duration (74 ± 17 versus 120 ± 49 minutes p < 0.05) was shorter for CB2 group; the fluoroscopy time (14 ± 17 versus 16 ± 5 minutes, p = 0.45) was similar. Complete PVI was achieved in 96% of patients with RF-CF and 98% with CB2. Phrenic nerve palsies (2 transient and 1 persistent) occurred exclusively in the CB2 group and 1 severe, nonlethal complication (pericardial tamponade) occurred in the CF-RF group. At 24-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia (AT) after a single procedure without antiarrhythmic drug, was comparable in CF-RF group and CB2 group (65.5% versus 67%, resp., log rank p = 0.54). Conclusion. Both the CB2 and the RF-CF ablation appeared safe; the success rate at 2 years was comparable between both technologies.
Collapse
|