1
|
Yamaguchi J, Takigawa M, Goya M, Martin CA, Negishi M, Yamamoto T, Ikenouchi T, Goto K, Shigeta T, Kawamura I, Nishimura T, Takamiya T, Tao S, Miyazaki S, Sasano T. Impact of contact force on the lesion characteristics of very high-power short-duration ablation using a QDOT-MICRO catheter. J Arrhythm 2024; 40:247-255. [PMID: 38586837 PMCID: PMC10995585 DOI: 10.1002/joa3.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 04/09/2024] Open
Abstract
Background Lesion size is reported to become larger as contact force (CF) increases. However, this has not been systematically evaluated in temperature-guided very high-power short-duration (vHPSD) ablation, which was therefore the purpose of this study. Methods Radiofrequency applications (90 W/4 s, temperature-control mode) were performed in excised porcine myocardium with four different CFs of 5, 15, 25, and 35 g using QDOT-MICRO™ catheter. Ten lesions for each combination of settings were created, and lesion metrics and steam-pops were compared. Results A total of 320 lesions were analyzed. Lesion depth, surface area, and volume were smallest for CF of 5 g than for 15, 25, and 35 g (depth: 2.7 mm vs. 2.9 mm, 3.0 mm, 3.15 mm, p < .01; surface area: 38.4 mm2 vs. 41.8 mm2, 43.3 mm2, 41.5 mm2, p < .05; volume: 98.2 mm3 vs. 133.3 mm3, 129.4 mm3, 126.8 mm3, p < .01 for all pairs of groups compared to CF = 5 g). However, no significant differences were observed between CFs of 15-35 g. Average power was highest for CF of 5 g, followed by 15, 25, and 35 g (83.2 W vs. 82.1 W vs. 77.1 W vs. 66.1 W, p < .01 for all pairs), reflecting the higher incidence of temperature-guided power titration with greater CFs (5 g:8.8% vs. 15 g:52.5% vs. 25 g:77.5% vs. 35 g:91.2%, p < .01 for all pairs except for 25 g vs. 35 g). The incidence of steam-pops did not significantly differ between four groups (5 g:3.8% vs. 15 g:10% vs. 25 g:6.2% vs. 35 g:2.5%, not significant for all pairs). Conclusions For vHPSD ablation, lesion size does not become large once the CF reaches 15 g, and the risk of steam-pops may be mitigated through power titration even in high CFs.
Collapse
Affiliation(s)
- Junji Yamaguchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
- Department of Clinical and Diagnostic Laboratory ScienceTokyo Medical and Dental UniversityTokyoJapan
| | - Masateru Takigawa
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | | | - Miho Negishi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tasuku Yamamoto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takashi Ikenouchi
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Kentaro Goto
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takatoshi Shigeta
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Iwanari Kawamura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Takuro Nishimura
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tomomasa Takamiya
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Susumu Tao
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Shinsuke Miyazaki
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental University HospitalTokyoJapan
| |
Collapse
|
2
|
Melero-Polo J, Cabrera-Ramos M, Alfonso-Almazán JM, Marín-García I, Montilla-Padilla I, Ruiz-Arroyo JR, López-Rodríguez G, Ramos-Maqueda J. Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach. Front Cardiovasc Med 2024; 10:1322743. [PMID: 38239876 PMCID: PMC10794657 DOI: 10.3389/fcvm.2023.1322743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction A new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation. Methods We conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences. Results A total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (-23.3 ± 4.9% vs. -18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up. Conclusions LI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.
Collapse
Affiliation(s)
- Jorge Melero-Polo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Mercedes Cabrera-Ramos
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | | | - Isabel Montilla-Padilla
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - José Ramón Ruiz-Arroyo
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | | | - Javier Ramos-Maqueda
- Arrhythmias Unit, Department of Cardiology, Aragón Health Research Institute, University Hospital Clínico Lozano Blesa, Zaragoza, Spain
| |
Collapse
|
3
|
Chen WT, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Hsieh YC, Li CH, Chen SA. Lower contact force predicts right pulmonary vein carina breakthrough after ablation index-guided pulmonary vein isolation using high-power short-duration. J Cardiovasc Electrophysiol 2024; 35:60-68. [PMID: 37888200 DOI: 10.1111/jce.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Carina breakthrough (CB) at the right pulmonary vein (RPV) can occur after circumferential pulmonary vein isolation (PVI) due to epicardial bridging or transient tissue edema. High-power short-duration (HPSD) ablation may increase the incidence of RPV CB. Currently, the surrogate of ablation parameters to predict RPV CB is not well established. This study investigated predictors of RPV CB in patients undergoing ablation index (AI)-guided PVI with HPSD. METHODS The study included 62 patients with symptomatic atrial fibrillation (AF) who underwent AI-guided PVI using HPSD. Patients were categorized into two groups based on the presence or absence of RPV CB. Lesions adjacent to the RPV carina were assessed, and CB was confirmed through residual voltage, low voltage along the ablation lesions, and activation wavefront propagation. RESULTS Out of the 62 patients, 21 (33.87%) experienced RPV CB (Group 1), while 41 (66.13%) achieved first-pass RPV isolation (Group 2). Despite similar AI and HPSD, patients with RPV CB had lower contact force (CF) at lesions adjacent to the RPV carina. Receiver operating characteristic (ROC) curve analysis identified CF < 10.5 g as a predictor of RPV CB, with 75.7% sensitivity and 56.2% specificity (area under the curve: 0.714). CONCLUSION In patients undergoing AI-guided PVI with HPSD, lower CF adjacent to the carina was associated with a higher risk of RPV CB. These findings suggest that maintaining higher CF during ablation in this region may reduce the occurrence of RPV CB.
Collapse
Affiliation(s)
- Wei-Tso Chen
- Department of Medicine, Division of Cardiology, Hualien Tzu Chi, Hospital, Hualien, Taiwan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ling Kuo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Cheng-I Wu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shin-Huei Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Cheng-Hung Li
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| |
Collapse
|
4
|
Kim H, Esser-Kahn AP, Rowan SJ, Jaeger HM. Stress-activated friction in sheared suspensions probed with piezoelectric nanoparticles. Proc Natl Acad Sci U S A 2023; 120:e2310088120. [PMID: 38015840 DOI: 10.1073/pnas.2310088120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023] Open
Abstract
A hallmark of concentrated suspensions is non-Newtonian behavior, whereby the viscosity increases dramatically once a characteristic shear rate or stress is exceeded. Such strong shear thickening is thought to originate from a network of frictional particle-particle contact forces, which forms under sufficiently large stress, evolves dynamically, and adapts to changing loads. While there is much evidence from simulations for the emergence of this network during shear thickening, experimental confirmation has been difficult. Here, we use suspensions of piezoelectric nanoparticles and exploit the strong local stress focusing within the network to activate charge generation. This charging can then be detected in the measured ac conductance and serve as a signature of frictional contact formation. The direct link between stress-activated frictional particle interactions and piezoelectric suspension response is further demonstrated by tracking the emergence of structural memory in the contact network under oscillatory shear and by showing how stress-activated friction can drive mechano-transduction of chemical reactions with nonlinear reaction kinetics. Taken together, this makes the ac conductance of piezoelectric suspensions a sensitive in-situ reporter of the micromechanics associated with frictional interactions.
Collapse
Affiliation(s)
- Hojin Kim
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637
- James Franck Institute and Department of Physics, University of Chicago, Chicago, IL 60637
| | - Aaron P Esser-Kahn
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637
| | - Stuart J Rowan
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL 60637
- Department of Chemistry, University of Chicago, Chicago, IL 60637
- Chemical and Engineering Sciences Division, Argonne National Laboratory, Lemont, IL 60439
| | - Heinrich M Jaeger
- James Franck Institute and Department of Physics, University of Chicago, Chicago, IL 60637
| |
Collapse
|
5
|
Dantas P, Gonçalves SR, Grenho A, Mascarenhas V, Martins J, Tavares da Silva M, Gonçalves SB, Guimarães Consciência J. Hip joint contact pressure and force: a scoping review of in vivo and cadaver studies. Bone Joint Res 2023; 12:712-721. [PMID: 38043570 PMCID: PMC10693937 DOI: 10.1302/2046-3758.1212.bjr-2022-0461.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Aims Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters. Methods We used the PRISMA extension for scoping reviews for this literature search in three databases. After screening, 16 studies were included for the final analysis. Results The studies assessed different hip conditions like labrum status, the biomechanical effect of the cam, femoral version, acetabular coverage, and the effect of rim trimming. The testing and loading conditions were also quite diverse, and this disparity limits direct comparisons between the different researches. With normal anatomy the mean contact pressures ranged from 1.54 to 4.4 MPa, and the average peak contact pressures ranged from 2 to 9.3 MPa. Labral tear or resection showed an increase in contact pressures that diminished after repair or reconstruction of the labrum. Complete cam resection also decreased the contact pressure, and acetabular rim resection of 6 mm increased the contact pressure at the acetabular base. Conclusion To date there is no standardized methodology to access hip contact biomechanics in hip arthroscopy, or with the preservation of the periarticular soft-tissues. A tendency towards improved biomechanics (lower contact pressures) was seen with labral repair and reconstruction techniques as well as with cam correction.
Collapse
Affiliation(s)
- Pedro Dantas
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Lisbon, Portugal
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Sergio R. Gonçalves
- Orthopaedic and Traumatology Center, Hospital CUF Descobertas, Lisbon, Portugal
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - André Grenho
- Department of Orthopaedic Surgery, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | | | - Jorge Martins
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | |
Collapse
|
6
|
Chen F, Liu Y, Wang Y, Gu Y, Yu Y, Sun J. Deformation and Force Chain of Two-Dimensional Granular Systems under Continuous Loading. Materials (Basel) 2023; 16:5441. [PMID: 37570144 PMCID: PMC10419609 DOI: 10.3390/ma16155441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
A continuous loading experiment of a two-dimensional granular system was carried out and the experimental data were obtained by digital image correlation (DIC). The deformation field of the granular system and the changing laws of the deflection angle and coordination number of the granules on force chains with time were obtained. Based on the granule element method, the quantitative calculation of contact force was realized, and the internal force chains of the granular system were identified. The effects of contact force between granules and mechanical parameters on the evolution of force chains in a two-dimensional granular system under line loads were analyzed. The formation, evolution, and reconstruction of force chains in a granular system during loading, as well as the influence of the force chain network evolution on the macroscopic mechanical properties of granules were discussed. The experimental results indicated that the evolution of force chains was directly related to the number, geometric properties, and permutation distribution of granules in direct contact with the external load.
Collapse
Affiliation(s)
- Fanxiu Chen
- School of Science, Qingdao University of Technology, Qingdao 266520, China; (Y.L.); (Y.W.); (Y.G.); (Y.Y.)
| | - Yuxin Liu
- School of Science, Qingdao University of Technology, Qingdao 266520, China; (Y.L.); (Y.W.); (Y.G.); (Y.Y.)
| | - Yuan Wang
- School of Science, Qingdao University of Technology, Qingdao 266520, China; (Y.L.); (Y.W.); (Y.G.); (Y.Y.)
| | - Yanji Gu
- School of Science, Qingdao University of Technology, Qingdao 266520, China; (Y.L.); (Y.W.); (Y.G.); (Y.Y.)
| | - Yang Yu
- School of Science, Qingdao University of Technology, Qingdao 266520, China; (Y.L.); (Y.W.); (Y.G.); (Y.Y.)
| | - Jie Sun
- School of Civil Engineering, Qingdao University of Technology, Qingdao 266520, China;
| |
Collapse
|
7
|
Zhang R, Chu H, Liu S, Yang B, Han B, Xiao X, Ma C, Sun Y, Yin X, Xia Y, Gao L. Catheter ablation of atrial fibrillation using FireMagic TrueForce ablation catheter: The TRUEFORCE trial. Pacing Clin Electrophysiol 2023; 46:986-993. [PMID: 37334721 DOI: 10.1111/pace.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The use of contact force (CF) sensing catheters has provided a revolutionary improvement in catheter ablation (CA) of atrial fibrillation (AF) in the past decade. However, the success rate of CA for AF remains limited, and some complications still occur. METHODS The TRUEFORCE trial (Catheter Ablation of Atrial Fibrillation using FireMagic TrueForce Ablation Catheter) is a multicenter, prospective, single-arm objective performance criteria study of AF patients who underwent their first CA procedure using FireMagic TrueForce ablation catheter. RESULTS A total of 120 patients (118 with paroxysmal AF) were included in this study, and 112 patients included in the per-protocol analysis. Pulmonary vein isolation (PVI) was achieved in 100% of the patients, with procedure and fluoroscopy time of 146.63 ± 40.51 min and 12.89 ± 5.59 min, respectively. Freedom from recurrent atrial arrhythmia after ablation was present 81.25% (95% confidence interval [CI]: 72.78%-88.00%) of patients. No severe adverse events (death, stroke/transient ischemic attack [TIA], esophageal fistula, myocardial infarction, thromboembolism, or pulmonary vein stenosis) were detected during the follow-up. Four (4/115, 3.33%) adverse events were documented, including one abdominal discomfort, one femoral artery hematoma, one coughing up blood, and one postoperative palpitation and insomnia. CONCLUSIONS This study demonstrated the clinical feasibility of FireMagic force-sensing ablation catheter in CA of AF, with a satisfactory short- and long-term efficacy and safety.
Collapse
Affiliation(s)
- Rongfeng Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huimin Chu
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai, China
| | - Bing Yang
- Department of Cardiology, Dongfang Hospital Affiliated to Tongji University, Shanghai, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Xianjie Xiao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chengming Ma
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuanjun Sun
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
8
|
Lambert Cause J, Solé Morillo Á, da Silva B, García-Naranjo JC, Stiens J. Novel Multi-Parametric Sensor System for Comprehensive Multi-Wavelength Photoplethysmography Characterization. Sensors (Basel) 2023; 23:6628. [PMID: 37514922 PMCID: PMC10384342 DOI: 10.3390/s23146628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Photoplethysmography (PPG) is widely used to assess cardiovascular health. However, its usage and standardization are limited by the impact of variable contact force and temperature, which influence the accuracy and reliability of the measurements. Although some studies have evaluated the impact of these phenomena on signal amplitude, there is still a lack of knowledge about how these perturbations can distort the signal morphology, especially for multi-wavelength PPG (MW-PPG) measurements. This work presents a modular multi-parametric sensor system that integrates continuous and real-time acquisition of MW-PPG, contact force, and temperature signals. The implemented design solution allows for a comprehensive characterization of the effects of the variations in these phenomena on the contour of the MW-PPG signal. Furthermore, a dynamic DC cancellation circuitry was implemented to improve measurement resolution and obtain high-quality raw multi-parametric data. The accuracy of the MW-PPG signal acquisition was assessed using a synthesized reference PPG optical signal. The performance of the contact force and temperature sensors was evaluated as well. To determine the overall quality of the multi-parametric measurement, an in vivo measurement on the index finger of a volunteer was performed. The results indicate a high precision and accuracy in the measurements, wherein the capacity of the system to obtain high-resolution and low-distortion MW-PPG signals is highlighted. These findings will contribute to developing new signal-processing approaches, advancing the accuracy and robustness of PPG-based systems, and bridging existing gaps in the literature.
Collapse
Affiliation(s)
- Joan Lambert Cause
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Department of Biomedical Engineering, Universidad de Oriente, Santiago de Cuba 90500, Cuba
| | - Ángel Solé Morillo
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| | - Bruno da Silva
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| | | | - Johan Stiens
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| |
Collapse
|
9
|
Lepillier A, Maggio R, De Sanctis V, Malacrida M, Stabile G, Zakine C, Champ-Rigot L, Anselmino M, Segreti L, Dell’Era G, Garnier F, Mascia G, Pandozi C, Dello Russo A, Scaglione M, Cosaro G, Ferraro A, Paziaud O, Maglia G, Solimene F. Insight into contact force local impedance technology for predicting effective pulmonary vein isolation. Front Cardiovasc Med 2023; 10:1169037. [PMID: 37476572 PMCID: PMC10354239 DOI: 10.3389/fcvm.2023.1169037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created. Objective We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry. Methods A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included. Results In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, p < 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, p < 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was >21 Ω at anterior sites and >18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (r = 0.14, 95% CI: 0.13-0.16, p < 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (-0.22, -0.23 to -0.20, p < 0.0001 for CF; -0.27, -0.29 to -0.26, p < 0.0001 for LI drop). Conclusion An LI drop >21 Ω at anterior sites and >18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT. Clinical trial registration http://clinicaltrials.gov/, identifier: NCT03793998.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Matteo Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gabriele Dell’Era
- Azienda Ospedaliera Universitaria “Maggiore della Carità”, Novara, Italy
| | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy
| | | | | | | | | | | | - Francesco Solimene
- Department of Cardiac Electrophysiology and Arrhythmology, Clinica Montevergine, Mercogliano, Italy
| |
Collapse
|
10
|
Chen J, Wang J, Li M, Zhao Z, Ren J. Mesoscopic Mechanical Properties of Aggregate Structure in Asphalt Mixtures and Gradation Optimization. Materials (Basel) 2023; 16:4709. [PMID: 37445021 DOI: 10.3390/ma16134709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Particle media are widely used in engineering and greatly influence the performance of engineering materials. Asphalt mixtures are multi-phase composite materials, of which coarse aggregates account for more than 60%. These coarse aggregates form a stable structure to transfer and disperse traffic loads. Therefore, knowing how to adjust the structural composition of coarse aggregates to optimize their performance is the key to optimize the performance of asphalt mixtures. In this study, the effects of different roughness and different sizes on the interlocking force and contact force of coarse aggregates were investigated through means of simulation (DEM), and then the formation-evolution mechanism of the coarse aggregate structure and the role of different sizes of aggregates in the coarse aggregate structure were analyzed. Subsequently, the optimal ratio of coarse aggregates was explored through indoor tests, and finally, the gradation of asphalt mixture based on the optimization of fine structure was formed and verified through indoor tests. The results showed that the major model can effectively reveal the role of different types of aggregates in the fine structure and the relationship between the strength of contact forces between them and clarify that the strength of the fine structure increases with the increase in aggregate roughness. Hence, the coarse aggregate structure can be regarded as a contact force transmission system composed of some strong and sub-strong contact forces. Their formation-evolution mechanism can be regarded as a process of the formation of strong and sub-strong contact forces and the transformation from sub-strong contact force to strong contact force. Moreover, the dynamic stability of the optimized graded asphalt mixture was increased by 30%, and the fracture toughness was increased by 26%.
Collapse
Affiliation(s)
- Jingchun Chen
- School of Civil Engineering and Geomatics, Shandong University of Technology, Zibo 255000, China
| | - Jian Wang
- School of Civil Engineering and Geomatics, Shandong University of Technology, Zibo 255000, China
| | - Min Li
- School of Civil Engineering and Geomatics, Shandong University of Technology, Zibo 255000, China
| | - Zedong Zhao
- School of Transportation and Vehicle Engineering, Shandong University of Technology, Zibo 255000, China
| | - Jiaolong Ren
- School of Civil Engineering and Geomatics, Shandong University of Technology, Zibo 255000, China
| |
Collapse
|
11
|
Bilyea AJ, French SH, Abdullah HA. Modeling contact forces during human-robot interactions for performing activities of daily living. Proc Inst Mech Eng H 2023:9544119231179568. [PMID: 37300488 DOI: 10.1177/09544119231179568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study aims to characterize contact forces between humans and tools during activities of daily living (ADL) to provide information to a personal care robot. The study was conducted on non-impaired subjects to capture various static and dynamic force levels when making contact with three different robotic tools, each designed to perform an ADL task: hair brushing, face wiping, and face shaving. The static trial of the study involved 21 participants. Forces were collected at fixed locations for each task and used to develop models for each participant. Extraction of the maximum force levels was performed for both the maximum and desired levels of force. The dynamic trial involved 24 individuals. Participants were asked to maintain a comfortable level of force for the duration of their contact with the tool as the robot moved along its path to perform the ADL task. For the static and dynamic trials, higher forces were observed during hair brushing compared to the other two tasks. It was observed that the hair brushing task force at a specific contact point has an overall maximum of 55.66 N, while the maximum forces detected in the face wiping and face shaving tasks were 36.40 and 11.11 N, respectively. The forces collected were analyzed, and no trends were found relating the contact forces to the gender, height, or weight of the subjects. Based on the analysis of the results, recommendations have been made to enhance the force safety limits for the personal care robot working environment.
Collapse
Affiliation(s)
- Aubrianna Jn Bilyea
- Robotics Institute, School of Engineering, University of Guelph, Guelph, ON, Canada
| | - Steven H French
- Robotics Institute, School of Engineering, University of Guelph, Guelph, ON, Canada
| | - Hussein A Abdullah
- Robotics Institute, School of Engineering, University of Guelph, Guelph, ON, Canada
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Fan Y, Zhang L, Zheng C, Xue F, Wang Z, Wang X, Wang L. Contact forces and motion behavior of non-Newtonian fluid-solid food by coupled SPH-FEM method. J Food Sci 2023. [PMID: 37125946 DOI: 10.1111/1750-3841.16581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/14/2023] [Accepted: 04/01/2023] [Indexed: 05/02/2023]
Abstract
The non-Newtonian fluid-solid interaction food has complex physical properties and complicated contact force, which brings the greater technical challenge to improving the food fetching rate. In this work, we used the smooth particle hydrodynamics and finite element coupling method for a node-to-surface penalty function contact to characterize the contact forces between non-Newtonian fluid food and solid foods. The shear rheological properties and density of non-Newtonian fluid food, including xanthan gum (XG) and guar gum (GG), were investigated by a viscometer and densitometer, respectively. The results showed that the shear viscosity of non-Newtonian fluid food depends to some extent on the mass ratio of the thickening gums. We investigated the effects of the end-effector with different fetching velocities and different inclination angles, and the nut root powder paste (NRPP) food with different ratios of XG and GG, on the fetching rate, stress-strain, and motion behavior. The results showed that the stress increased with increasing v1 and w; however, the v2 had less effect on the stress. The sparseness of the distribution of solid food was related to the v1 and w, whereas it was less influenced by the v2 . The distribution of solid food became denser in the X-Z plane and sparser in the X-Y plane with increasing inclination angle. The motion behavior of viscoelastic solid foods depended on the mass ratio of XG to GG dissolved in NRPP. The present work can provide a theoretical foundation for meal-assisting robots and robots in the field of food engineering with the task of improving the food fetching rate.
Collapse
Affiliation(s)
- Yuhe Fan
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| | - Lixun Zhang
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| | | | - Feng Xue
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| | - Zhenhan Wang
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| | - Xingyuan Wang
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| | - Lan Wang
- College of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China
| |
Collapse
|
14
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
15
|
Wang S, Yu W, Miao Y, Wang L. Review on Load Transfer Mechanisms of Asphalt Mixture Meso-Structure. Materials (Basel) 2023; 16:1280. [PMID: 36770290 PMCID: PMC9919407 DOI: 10.3390/ma16031280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Asphalt mixture is a skeleton filling system consisting of aggregate and asphalt binder. Its performance is directly affected by the internal load transfer mechanism of the skeleton filling system. It is significant to understand the load transfer mechanisms for asphalt mixture design and performance evaluation. The objective of this paper is to review the research progress of the asphalt mixture load transfer mechanism. Firstly, this paper summarizes the test methods used to investigate the load transfer mechanism of asphalt mixtures. Then, an overview of the characterization of load transfer mechanism from three aspects was provided. Next, the indicators capturing contact characteristics, contact force characteristics, and force chain characteristics were compared. Finally, the load transfer mechanism of asphalt mixtures under different loading conditions was discussed. Some recommendations and conclusions in terms of load transfer mechanism characterization and evaluation were given. The related work can provide valuable references for the study of the load transfer mechanism of asphalt mixtures.
Collapse
Affiliation(s)
- Sudi Wang
- National Center for Materials Service Safety, University of Science and Technology Beijing, Beijing 100083, China
| | - Weixiao Yu
- National Center for Materials Service Safety, University of Science and Technology Beijing, Beijing 100083, China
| | - Yinghao Miao
- National Center for Materials Service Safety, University of Science and Technology Beijing, Beijing 100083, China
| | - Linbing Wang
- National Center for Materials Service Safety, University of Science and Technology Beijing, Beijing 100083, China
- School of Environmental, Civil, Agricultural and Mechanical Engineering, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
16
|
Kueffer T, Haeberlin A, Knecht S, Baldinger SH, Madaffari A, Seiler J, Mühl A, Tanner H, Roten L, Reichlin T. Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters. J Cardiovasc Electrophysiol 2023; 34:292-299. [PMID: 36490307 DOI: 10.1111/jce.15770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.
Collapse
Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aline Mühl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
17
|
Pelosi F. Can we trust the force? J Cardiovasc Electrophysiol 2023; 34:300-301. [PMID: 36482011 DOI: 10.1111/jce.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Frank Pelosi
- Department of Internal Medicine, Cardiac Electrophysiology Section, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
18
|
Kawakami S, Ogawa E, Fukaya H, Matsuura G, Aiga S, Kumagai H. Estimation of mechanical properties by transcatheter monitoring using local impedance and contact force. J Med Eng Technol 2023; 47:141-146. [PMID: 36426804 DOI: 10.1080/03091902.2022.2134479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The mechanical properties of the myocardium in the left ventricle and right atrium were estimated by simultaneously measuring the local impedance (LI) and contact force (CF) using an ablation catheter. Radiofrequency catheter ablation (RFCA) is a well-established arrhythmia treatment. Monitoring the RF power, CF and properties of myocardium during RFCA are necessary to estimate the effect of ablation. Indices, such as CF, lesion size index and ablation index, do not include the myocardium mechanical properties. Therefore, there is the risk of side effects, such as cardiac tamponade, by excessive catheter indentation into vulnerable areas. We propose the simultaneous measurement of LI and CF for estimating the myocardial mechanical properties to reduce the side effects. In this study, an in vitro experimental system was constructed to measure LI and CF via the catheter. The relationship between the porcine myocardial tissue thickness and CF-LI curve was investigated using the left ventricle and right atrium. Power function coefficients approximating the CF-LI curve increased with thicker left ventricle. The thickness of the myocardium can be estimated by simultaneously measuring LI and CF. Intraoperative measurement of the myocardial mechanical properties can be used to determine the ablation conditions at each site.
Collapse
Affiliation(s)
- Sota Kawakami
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Emiyu Ogawa
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Sumire Aiga
- Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroshi Kumagai
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
| |
Collapse
|
19
|
Pang N, Gao J, Zhang N, Guo M, Wang R. Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 9:1060542. [PMID: 36684611 PMCID: PMC9853203 DOI: 10.3389/fcvm.2022.1060542] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
Collapse
Affiliation(s)
- Naidong Pang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia Gao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Nan Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Rui Wang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Rui Wang,
| |
Collapse
|
20
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
21
|
Francis C, Sato T, Okuyama T, Tanaka M. A cable driven robotic palpation system with contact force sensing based on cable tension observation. Int J Med Robot 2022; 18:e2435. [PMID: 35727607 PMCID: PMC9786714 DOI: 10.1002/rcs.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prostate Cancer screening based on manual palpation is subjective. Robotic palpation systems can objectively acquire stiffness conditions of the prostate. METHODS A 2DoF cable driven robotic system for prostate palpation is proposed. An indirect method to estimate the contact force based on cable tension observation is presented. Kinematic models and a joint angle estimation method to determine the tip position of the probe are derived. Positioning accuracy was verified using an optical marker tracking system and by displacement measurement, respectively. The contact force estimation method was validated on silicone phantom samples. RESULTS A good consistence between the estimated and measured contact force was observed. The contact force was correlated with the elastic modulus of each silicone phantom. There was also a good agreement between the theoretical and the measured tip position. CONCLUSION In the proposed palpation system, the indirect contact force estimation method is viable and holds potential for the stiffness assessment of the prostate. The tip position vital for palpation can be determined through estimated joint angles.
Collapse
Affiliation(s)
- Chikweto Francis
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Taiga Sato
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| | - Takeshi Okuyama
- Department of RoboticsGraduate School of EngineeringTohoku UniversitySendaiJapan
| | - Mami Tanaka
- Department of Biomedical EngineeringGraduate School of Biomedical EngineeringTohoku UniversitySendaiJapan
| |
Collapse
|
22
|
Hartl S, Auf der Heiden C, Bejinariu A, Clasen L, Füting A, Vom Dahl S, Lüdde T, Kelm M, Makimoto H. Radiofrequency Pulmonary Vein Isolation without Esophageal Temperature Monitoring: Contact-Force Characteristics and Incidence of Esophageal Thermal Damage. J Clin Med 2022; 11. [PMID: 36498492 DOI: 10.3390/jcm11236917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Esophageal thermal lesions following pulmonary vein isolation (PVI) for atrial fibrillation (AF) potentially harbor lethal complications. Radiofrequency (RF)-PVI using contact force-technology can reduce collateral damage. We evaluated the incidence of endoscopically detected esophageal lesions (EDEL) and the contribution of contact force to esophageal lesion formation without esophageal temperature monitoring. One hundred and thirty-one AF patients underwent contact force-guided RF-PVI. Contact force, energy, force-time-integral, and force-power-time-integral were adopted. During PVI at the posterior segment of the wide antral circumferential line, limits were set for energy (30 W), duration (30 s) and contact force (40 g). Ablations were analyzed postero-superior and -inferior around PVs. Endoscopy within 120 h identified EDEL in six patients (4.6%). In EDEL(+), obesity was less frequent (17% vs. 68%, p = 0.018), creatinine was higher (1.55 ± 1.18 vs. 1.07 ± 0.42 mg/dL, p = 0.016), and exclusively at the left postero-inferior site, force-time-integral and force-power-time-integral were greater (2973 ± 3267 vs. 1757 ± 1262 g·s, p = 0.042 and 83,547 ± 105,940 vs. 43,556 ± 35,255 g·J, p = 0.022, respectively) as compared to EDEL(-) patients. No major complications occurred. At 12 months, arrhythmia-free survival was 74%. The incidence of EDEL was low after contact force-guided RF-PVI. Implementing combined contact force-indices on the postero-inferior site of left-sided PVs may reduce EDEL.
Collapse
|
23
|
Jiang R, Chen M, Fan J, Yi F, Tang A, Liu X, Zhu W, Liu S, Huang X, Liu Q, Ju W, Zhang X, Li J, He J, Shi L, Zhou G, Wang Y, Fu G, Jiang C. Efficacy of ablation index-guided pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:1186-1193. [PMID: 35939332 DOI: 10.1111/pace.14578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation index (AI) is a novel technology of ablation lesion quality to help improve homogeneity of lesion size and continuity. In this study, we aim to evaluate whether AI-guided PVI improves clinical outcomes compared to CF-guided PVI in patients with paroxysmal AF (PAF). METHODS Patients undergoing first-time radiofrequency ablation for PAF were randomized in a 2:1 ratio to two groups: AI-guided PVI and CF-guided PVI. In the AI group, AI ≥500 was recommended at the anterior/superior/inferior walls, 350-400 at the posterior wall, and inter-lesion distance ≤4 mm. The primary endpoint is the freedom from atrial arrhythmia recurrence during 12 months follow-up, without antiarrhythmic drug therapy (ADT). The key secondary endpoints include intra-procedural efficiency and peri-procedural complications. RESULTS 225 patients were randomized (AI group (n = 149) and CF group(n = 76)). First-pass isolation rate in AI group was significantly higher than that in CF group (58.3% vs. 43.4%, p = 0.035). After a median follow-up of 12.2 months, 154/225(68.4%) of patients were free from atrial arrhythmia recurrence without ADT, which was higher in AI group compared with CF group, but without significant difference (71.1% vs. 63.2%, p = 0.253). The incidence of peri-procedural complications is low and without difference between two groups. CONCLUSIONS AI-guided ablation provided higher acute efficacy than CF-guided ablation in PV isolation for patients with paroxysmal AF. The long-term success rate in AI group was higher than CF group, but did not reach statistical significance. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ruhong Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Fan
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Fu Yi
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Anli Tang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingpeng Liu
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Wenqing Zhu
- The Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaowen Liu
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobo Huang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Liu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weizhu Ju
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi Zhang
- The First Peoples' Hospital of Yunnan Province, Yunnan, China
| | - Jie Li
- Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jiangui He
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Shi
- Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing, China
| | - Genqing Zhou
- Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuegang Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guosheng Fu
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyang Jiang
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
24
|
Kotake Y, Kanawati J, Kumar S. Will the insulated-tip radiofrequency catheter transform ablation procedures? J Cardiovasc Electrophysiol 2022; 33:1157-1159. [PMID: 35322476 DOI: 10.1111/jce.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
Radiofrequency (RF) ablation has been the most widely employed energy source for catheter ablation to date. However, most of conventional RF ablation energy dissipates into the bloodstream before reaching the target tissue. Technology that conveys RF energy exclusively toward target tissue may potentially improve the quality, safety, and outcome of the RF ablation procedures. RF ablation using a novel insulated-tip catheter (SMT, Sirona Medical Technologies, Windsor, CT) may refine RF ablation in the future to minimize the risk of iatrogenic complications. Although it is still unclear whether the results of the SMT catheter can be translated to a human beating heart, the data for SMT catheter of this study are very promising. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, NSW, Australia.,Westmead Applied Research Centre, University of Sydney
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, NSW, Australia.,Westmead Applied Research Centre, University of Sydney
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, NSW, Australia.,Westmead Applied Research Centre, University of Sydney
| |
Collapse
|
25
|
Themistoclakis S, Calzolari V, De Mattia L, China P, Russo AD, Fassini G, Casella M, Caporaso I, Indiani S, Addis A, Basso C, Della Barbera M, Thiene G, Tondo C. In vivo Lesion Index (LSI) validation in percutaneous radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2022; 33:874-882. [PMID: 35262242 DOI: 10.1111/jce.15442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/06/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Lesion Index (LSI) has been developed to predict lesion efficacy during radiofrequency (RF) catheter ablation. However, its value in predicting lesions size has still to be established. The aim of our study was to assess the lesions size reproducibility for pre-specified values of LSI reached during RF delivery in an in vivo beating heart. METHODS Ablation lesions were created with different values of LSI in 7 domestic pigs by means of a contact force sensing catheter (TactiCathTM , Abbott). Lesions were identified during RF delivery by means of a 3D mapping system (EnSiteTM Precision, Abbott) and measured after heart explantation. Histology was carried out after gross examination on the first 3 lesions to confirm the accuracy of the macroscopic evaluation. RESULTS A total of 64 myocardial lesions were created. Thirty-nine lesions were excluded from the analysis for the following reasons: histological confirmation of macroscopic lesion measurement (n=3), transmurality (n=24), unfavorable anatomic position (n=10), not macroscopically identifiable (n=2). In a final set of 25 non-transmural lesions, injury width and depth were respectively 4.6±0.6 mm and 2.6±0.8 mm for LSI=4, 7.3±0.8 mm and 4.7±0.6 mm for LSI=5, and 8.6±1.2 mm and 7.2±1.1 mm for LSI=6. A strong linear correlation was observed between LSI and lesion width (r=0.87, p<0.00001) and depth (r=0.89, p<0.00001). Multiple linear regression analysis identified LSI as the only ablation parameter that significantly predicted lesion width (p<0.001) and depth (p<0.001). CONCLUSION In our in vivo study, LSI proved highly predictive of lesion size and depth. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | | | - Luca De Mattia
- Ospedale Ca'Foncello-ULSS2 Marca Trevigiana, Treviso, Italy
| | - Paolo China
- Ospedale dell'Angelo-ULSS3 Serenissima, Mestre-Venice, Italy
| | | | - Gaetano Fassini
- Heart Rhythm Center, Monzino Cardiac Center, IRCCS, Milan, Italy
| | - Michela Casella
- Heart Rhythm Center, Monzino Cardiac Center, IRCCS, Milan, Italy
| | - Igor Caporaso
- Abbott Medical Italia S.p.A., Sesto San Giovanni, Italy
| | | | - Alessandro Addis
- CRABCC, Biotechnology Research Center for Cardiothoracic Applications, Rivolta D'Adda, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Mila Della Barbera
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Monzino Cardiac Center, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
26
|
Hiner E, Shah DP. Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation. J Innov Card Rhythm Manag 2022; 12:4790-4795. [PMID: 34970468 PMCID: PMC8712057 DOI: 10.19102/icrm.2021.121205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2021] [Indexed: 11/20/2022] Open
Abstract
A stable contact force (CF) is correlated with more effective radiofrequency (RF) ablation (RFA) lesions and long-term procedural outcomes. Efforts to improve catheter stability include jet ventilation, pacing, steerable sheaths, and CF-sensing ablation catheters. This study compares CF stability and effective RF lesions between two commercially available steerable sheaths. Thirty patients underwent first-time RFA at a single center using the Agilis™ NxT (Abbott, Chicago, IL, USA) or SureFlex™ (Baylis Medical, Montreal, Canada) steerable sheath. High-power short-duration RFA was utilized, targeting a 10-Ω drop. Sheath performance was assessed for the entire procedure and around each pulmonary vein (PV) in terms of mean CF, CF variability, RF time per lesion, and inefficient contact lesions (defined as lesions with a CF of less than 5 g for at least 10% of the RF delivery time). The operator-targeted mean CF was achieved using both sheaths; however, the overall CF variability was 12.8% lower when using the SureFlex™ sheath (p = 0.08). The CF variability was generally 16% greater in the right PVs than the left PVs (p = 0.001) but trended lower with the SureFlex™ sheath. There were 8% more inefficient contact lesions created when using the Agilis™ sheath as compared to the SureFlex™ sheath (p = 0.035), especially in the right inferior PV (p = 0.009). The RF time per lesion was, on average, 12% (1.4 seconds) shorter when using the SureFlex™ sheath than the Agilis™ sheath (p < 0.05). The choice of steerable sheath may affect both catheter stability and lesion quality, especially in the right PVs.
Collapse
Affiliation(s)
- Evan Hiner
- Ascension Health Providence Hospital and Medical Center, Southfield, MI, USA
| | - Dipak P Shah
- Ascension Health Providence Hospital and Medical Center, Southfield, MI, USA
| |
Collapse
|
27
|
Sritharan P, Schache AG, Culvenor AG, Perraton LG, Bryant AL, Morris HG, Whitehead TS, Crossley KM. Patellofemoral and tibiofemoral joint loading during a single-leg forward hop following ACL reconstruction. J Orthop Res 2022; 40:159-169. [PMID: 33871078 DOI: 10.1002/jor.25053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Altered biomechanics are frequently observed following anterior cruciate ligament reconstruction (ACLR). Yet, little is known about knee-joint loading, particularly in the patellofemoral-joint, despite patellofemoral-joint osteoarthritis commonly occurring post-ACLR. This study compared knee-joint reaction forces and impulses during the landing phase of a single-leg forward hop in the reconstructed knee of people 12-24 months post-ACLR and uninjured controls. Experimental marker data and ground forces for 66 participants with ACLR (28 ± 6 years, 78 ± 15 kg) and 33 uninjured controls (26 ± 5 years, 70 ± 12 kg) were input into scaled-generic musculoskeletal models to calculate joint angles, joint moments, muscle forces, and the knee-joint reaction forces and impulses. The ACLR group exhibited a lower peak knee flexion angle (mean difference: -6°; 95% confidence interval: [-10°, -2°]), internal knee extension moment (-3.63 [-5.29, -1.97] percentage of body weight × participant height (body weight [BW] × HT), external knee adduction moment (-1.36 [-2.16, -0.56]% BW × HT) and quadriceps force (-2.02 [-2.95, -1.09] BW). The ACLR group also exhibited a lower peak patellofemoral-joint compressive force (-2.24 [-3.31, -1.18] BW), net tibiofemoral-joint compressive force (-0.74 [-1.20, 0.28] BW), and medial compartment force (-0.76 [-1.08, -0.44] BW). Finally, only the impulse of the patellofemoral-joint compressive force was lower in the ACLR group (-0.13 [-0.23, -0.03] body weight-seconds). Lower compressive forces are evident in the patellofemoral- and tibiofemoral-joints of ACLR knees compared to uninjured controls during a single-leg forward hop-landing task. Our findings may have implications for understanding the contributing factors for incidence and progression of knee osteoarthritis after ACLR surgery.
Collapse
Affiliation(s)
- Prasanna Sritharan
- La Trobe Sports & Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sports & Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sports & Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Luke G Perraton
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Hayden G Morris
- Park Clinic Orthopaedics, St Vincent's Private Hospital, Melbourne, Victoria, Australia
| | | | - Kay M Crossley
- La Trobe Sports & Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Abstract
This paper presents an observer architecture that can estimate a set of configuration space variables, their rates of change and contact forces of a fabric-reinforced inflatable soft robot. We discretized the continuum robot into a sequence of discs connected by inextensible threads; this allows great flexibility when describing the robot’s behavior. At first, the system dynamics is described by a linear parameter-varying (LPV) model that includes a set of subsystems, each of which corresponds to a particular range of chamber pressure. A real-world challenge we confront is that the physical robot prototype exhibits a hysteresis loop whose directions depend on whether the chamber is inflating or deflating. In this paper we transform the hysteresis model to a semilinear model to avoid backward-in-time definitions, making it suitable for observer and controller design. The final model describing the soft robot, including the discretized continuum and hysteresis behavior, is called the semilinear parameter-varying (SPV) model. The semilinear parameter-varying observer architecture includes a set of sub-observers corresponding to the subsystems for each chamber pressure range in the SPV model. The proposed observer is evaluated through simulations and experiments. Simulation results show that the observer can estimate the configuration space variables and their rate of change with no steady-state error. In addition, experimental results display fast convergence of generalized contact force estimates and good tracking of the robot’s configuration relative to ground-truth motion capture data.
Collapse
Affiliation(s)
- Phuc D H Bui
- Department of Mechanical Engineering, The University of Tulsa, Tulsa, OK, United States
| | - Joshua A Schultz
- Department of Mechanical Engineering, The University of Tulsa, Tulsa, OK, United States
| |
Collapse
|
29
|
Tsutsui K, Kawano D, Mori H, Kato R, Ikeda Y, Sumitomo N, Fukaya H, Iwanaga S, Nakano S, Muramatsu T, Matsumoto K. Characteristics and optimal ablation settings of a novel, contact-force sensing and local impedance-enabled catheter in an ex vivo perfused swine ventricle model. J Cardiovasc Electrophysiol 2021; 32:3187-3194. [PMID: 34559441 DOI: 10.1111/jce.15253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/25/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local impedance (LI) has emerged as a new technology that informs on electrical catheter-tissue coupling during radiofrequency (RF) ablation. Recently, IntellaNav StablePoint, a novel LI-enabled catheter that equips contact force (CF) sensing, has been introduced. Although StablePoint and its predecessor IntellaNav MiFi OI share the common technology that reports LI, distinct mechanics for LI sensing between the two products raise a concern that the LI-RF lesion formation relationship may differ. METHODS In an ex vivo swine cardiac tissue model, we investigated the initial level and range of a reduction in LI during a 60-s RF ablation and the resultant lesion characteristics at nine combinations of three energy power (30, 40, and 50 W) and CF (10, 30, and 50 g) steps. Correlations and interactions between CF, LI, wattage, and formed lesions were analyzed. Incidence of achieving LI drop plateau and that of a steam pop were also determined. RESULTS Positive correlations existed between CF and initial LI, CF and absolute/relative LI drop, CF and lesion volume, and LI drop and lesion volume. At the same LI drop, wattage-dependent gain in lesion volume was observed. Steam pops occurred in all CF steps and the prevalence was highest at 50 W. LI drop predicted a steam pop with a cutoff value at 89Ω. CONCLUSION In StablePoint, wattage crucially affects LI drop and lesion volume. Because 30 W ablation may by underpowered for intramural lesion formation and 50 W often resulted in a steam pop, 40 W appears to achieve the balance between the safety and efficacy.
Collapse
Affiliation(s)
- Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| |
Collapse
|
30
|
Steven D, Lüker J, Sultan A. Novel Devices in Cardiac Interventional Therapy: Safety First! JACC Clin Electrophysiol 2021; 7:1022-4. [PMID: 34412866 DOI: 10.1016/j.jacep.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022]
|
31
|
Kawano D, Mori H, Kato R, Tsutsui K, Ikeda Y, Sumitomo N, Fukaya H, Iwagana S, Nakano S, Muramatsu T, Matsumoto K. The optimal ablation setting for a local impedance guided catheter in an in vitro experimental model. J Cardiovasc Electrophysiol 2021; 32:2069-2076. [PMID: 34185348 DOI: 10.1111/jce.15136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/20/2021] [Accepted: 06/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The local impedance (LI) reflects the electrical catheter-tissue coupling and correlates with the local tissue temperature. However, there have been few clinical studies showing the recommended method for LI monitoring catheters. This study aimed to investigate the optimal ablation setting for this catheter in an in vitro experimental model. METHODS LI monitoring catheters were used in an excised swine heart experimental model. The tissue contact force (CF) was directly monitored from an external weight scale. Radiofrequency ablation was performed with a combination of various energy power settings (30, 40, and 50 W), and various CFs (10, 30, and 50 g) for 60 s. The correlation between the LI-related indexes, power, and CF with the lesion formation was statistically analyzed. RESULTS A positive correlation between the LI or lesion formation and CF was observed under all powers. Although the LI drop always correlated with the maximum lesion depth, lesion diameter, and lesion volume, the coefficient of the correlation value was lower under a high CF (lesion depth, diameter, and volume; 10 g, r = 0.8064, r = 0.8389, r = 0.8477; 30 g, r = 0.7590, r = 0.8063, r = 0.8060; 50 g r = 0.5555, r = 0.5701, and r = 0.5678, respectively). Steam pops occurred only under a 50 W ablation and the LI drop cutoff value for steam pops was 46 Ω. CONCLUSION The same LI drop did not always lead to the same lesion size when the CF differed. Monitoring the LI and not exceeding 46 Ω would be useful for a safe ablation.
Collapse
Affiliation(s)
- Daisuke Kawano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshifumi Ikeda
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan
| | - Shiro Iwagana
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshihiro Muramatsu
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuo Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| |
Collapse
|
32
|
Kaneshiro T, Amami K, Hijioka N, Nodera M, Yamada S, Yokokawa T, Misaka T, Hikichi T, Yoshihisa A, Takeishi Y. Significance of Contact Force on Esophageal Thermal Injury During Relative High-Power Short-Duration Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009897. [PMID: 34111947 DOI: 10.1161/circep.121.009897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Kaneshiro
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan.,Department of Arrhythmia and Cardiac Pacing (T.K., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Amami
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy (T.H.), Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine (T.K., K.A., N.H., M.N., S.Y., T.Y., T.M., A.Y., Y.T.), Fukushima Medical University, Fukushima, Japan.,Department of Arrhythmia and Cardiac Pacing (T.K., Y.T.), Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
33
|
Roth JD, Howell SM, Hull ML. Tibial forces are more useful than varus-valgus laxities for identifying and correcting overstuffing in kinematically aligned total knee arthroplasty. J Orthop Res 2021; 39:1271-1280. [PMID: 32543736 DOI: 10.1002/jor.24779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/26/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
Identifying and correcting varus-valgus (V-V) malalignment of the tibial component is important when balancing a kinematically aligned total knee arthroplasty (TKA). Accordingly, the primary objective was to determine whether the tibial forces or V-V laxities are more sensitive to, and thus more useful for identifying and correcting, V-V malalignments of the tibial component that overstuff a compartment. Calipered kinematically aligned TKA was performed on nine human cadaveric knees. Medial and lateral tibial forces and V-V laxities were measured from 0° to 120° flexion with an unmodified reference tibial component and modified tibial components that introduced ±1° and ±2° V-V malalignments from the reference component to overstuff either the medial or lateral compartment. Changes in the tibial forces were most sensitive to V-V malalignments at 0° flexion (medial = 118 ± 34 N/deg valgus malalignment and lateral = 79 ± 20 N/deg varus malalignment). The varus and valgus laxities were most sensitive to V-V malalignments at 30° flexion (-0.6 ± 0.1 deg/deg varus malalignment) and 120° flexion (-0.4 ± 0.2 deg/deg valgus malalignment), respectively. The maximum average signal-to-noise ratios of the sensitivities in tibial forces and V-V laxities (ie, signals) to reported measurement errors using current intraoperative technologies (14 N and 0.7°) (ie, noise) were 8.4 deg-1 and 0.9 deg-1 , respectively. Because of the greater signal-to-noise ratios, measuring tibial forces is more useful than measuring V-V laxities for identifying and correcting V-V malalignments of the tibial component that overstuff a compartment. Clinical Significance: The sensitivities of tibial forces provide objective guidance to surgeons performing V-V recuts of the tibia.
Collapse
Affiliation(s)
- Joshua D Roth
- Biomedical Engineering Graduate Group, University of California, Davis, California.,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, California
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, California.,Department of Mechanical Engineering, University of California, Davis, California.,Department of Orthopaedic Surgery, University of California, Davis, California
| |
Collapse
|
34
|
Kumar V, Strickberger A. All Lesions Are Not Created Equal. JACC Clin Electrophysiol 2021; 7:378-379. [PMID: 33736755 DOI: 10.1016/j.jacep.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Vineet Kumar
- Cardiac Electrophysiology, Inova Heart and Vascular Center, Inova Health System, Fairfax, Virginia, USA.
| | - Adam Strickberger
- Cardiac Electrophysiology, Inova Heart and Vascular Center, Inova Health System, Fairfax, Virginia, USA
| |
Collapse
|
35
|
Osorio J, Hunter TD, Rajendra A, Zei P, Silverstein J, Morales G. Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 2021; 32:1814-1821. [PMID: 33825242 DOI: 10.1111/jce.15028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter-tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1-year clinical success after PAF ablation, including first pass isolation. METHODS Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide-area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10-20 s. Radiofrequency energy was set at 40-45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. RESULTS A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90-day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). CONCLUSION In a real-world setting, first pass isolation was highly predictive of 12-month clinical success after CF-guided ablation in a PAF population.
Collapse
Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Tina D Hunter
- CTI Clinical Trial & Consulting Services, Covington, Kentucky, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul Zei
- Brigham And Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | |
Collapse
|
36
|
Lo MY, Sanders P, Sommer P, Kalman JM, Siddiqui UR, Sundaram S, Piorkowski C, Olson N, Madej SM, Gibson DN. Safety and Effectiveness of a Next-Generation Contact Force Catheter: Results of the TactiSense Trial. JACC Clin Electrophysiol 2021; 7:1013-1021. [PMID: 33812831 DOI: 10.1016/j.jacep.2021.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this clinical trial was to evaluate the safety and effectiveness of the TactiCath Contact Force Ablation Catheter, Sensor Enabled (TactiCath SE) (Abbott, Abbott Park, Illinois) for the treatment of drug-refractory, symptomatic paroxysmal atrial fibrillation (PAF). BACKGROUND Catheter ablation of atrial fibrillation (AF) is an established therapy for the treatment of PAF. Ablation technology is evolving with the primary goals of improving efficacy and safety of the procedure. METHODS This was a multicenter single-arm trial evaluating a novel ablation catheter for the treatment of PAF. A total of 156 subjects were enrolled at 19 sites in the United States, Europe, and Australia. The primary safety endpoint was the rate of device- or procedure-related serious adverse events occurring within 7 days. The primary effectiveness endpoint was acute success defined as pulmonary vein isolation at 30 min after ablation. Two descriptive endpoints were prospectively captured: 1) 1-year freedom from recurrence of symptomatic AF, atrial flutter (AFL), and atrial tachycardia (AT) lasting ≥30 s without a new or increased dose of Class I/III antiarrhythmic drugs; and 2) 1-year drug-free success defined by the absence of any recurrent AF/AFL/AT lasting ≥30 s without using Class I/III antiarrhythmic drugs. RESULTS Primary safety events occurred in 4.7% of patients (95% confidence interval [CI]: 2.23% to 8.64%), and the procedure was acutely successful in 98.0% of patients (95% CI: 94.95% to 99.46%). According to Kaplan-Meier estimates at 1 year, 82.2% (95% CI: 74.7% to 87.6%) were free from symptomatic recurrence, and 1-year drug-free success was 68.2% (95% CI: 59.9% to 75.1%). CONCLUSIONS The TactiCath™ Contact Force Ablation Catheter, Sensor Enabled™ is safe and effective for the treatment of paroxysmal AF.
Collapse
Affiliation(s)
- Monica Y Lo
- Heart Rhythm Institute, Arkansas Heart Hospital, Little Rock, Arkansas, USA.
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Phillipp Sommer
- Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, University Hospital of Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Usman R Siddiqui
- Cardiology and Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida, USA
| | - Sri Sundaram
- Cardiac Electrophysiology Department, South Denver Cardiology Associates, Denver, Colorado, USA
| | | | - Nicholas Olson
- Cardiac Electrophysiology, Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, California, USA
| | - Steven M Madej
- Electrophysiology and Heart Failure Division, Abbott, Plymouth, Minnesota, USA
| | - Douglas N Gibson
- Cardiac Electrophysiology, Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, California, USA
| |
Collapse
|
37
|
Williams SE, Roney CH, Connolly A, Sim I, Whitaker J, O’Hare D, Kotadia I, O’Neill L, Corrado C, Bishop M, Niederer SA, Wright M, O’Neill M, Linton NWF. OpenEP: A Cross-Platform Electroanatomic Mapping Data Format and Analysis Platform for Electrophysiology Research. Front Physiol 2021; 12:646023. [PMID: 33716795 PMCID: PMC7952326 DOI: 10.3389/fphys.2021.646023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Electroanatomic mapping systems are used to support electrophysiology research. Data exported from these systems is stored in proprietary formats which are challenging to access and storage-space inefficient. No previous work has made available an open-source platform for parsing and interrogating this data in a standardized format. We therefore sought to develop a standardized, open-source data structure and associated computer code to store electroanatomic mapping data in a space-efficient and easily accessible manner. METHODS A data structure was defined capturing the available anatomic and electrical data. OpenEP, implemented in MATLAB, was developed to parse and interrogate this data. Functions are provided for analysis of chamber geometry, activation mapping, conduction velocity mapping, voltage mapping, ablation sites, and electrograms as well as visualization and input/output functions. Performance benchmarking for data import and storage was performed. Data import and analysis validation was performed for chamber geometry, activation mapping, voltage mapping and ablation representation. Finally, systematic analysis of electrophysiology literature was performed to determine the suitability of OpenEP for contemporary electrophysiology research. RESULTS The average time to parse clinical datasets was 400 ± 162 s per patient. OpenEP data was two orders of magnitude smaller than compressed clinical data (OpenEP: 20.5 ± 8.7 Mb, vs clinical: 1.46 ± 0.77 Gb). OpenEP-derived geometry metrics were correlated with the same clinical metrics (Area: R 2 = 0.7726, P < 0.0001; Volume: R 2 = 0.5179, P < 0.0001). Investigating the cause of systematic bias in these correlations revealed OpenEP to outperform the clinical platform in recovering accurate values. Both activation and voltage mapping data created with OpenEP were correlated with clinical values (mean voltage R 2 = 0.8708, P < 0.001; local activation time R 2 = 0.8892, P < 0.0001). OpenEP provides the processing necessary for 87 of 92 qualitatively assessed analysis techniques (95%) and 119 of 136 quantitatively assessed analysis techniques (88%) in a contemporary cohort of mapping studies. CONCLUSIONS We present the OpenEP framework for evaluating electroanatomic mapping data. OpenEP provides the core functionality necessary to conduct electroanatomic mapping research. We demonstrate that OpenEP is both space-efficient and accurately representative of the original data. We show that OpenEP captures the majority of data required for contemporary electroanatomic mapping-based electrophysiology research and propose a roadmap for future development.
Collapse
Affiliation(s)
- Steven E. Williams
- King’s College London, London, United Kingdom
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Adam Connolly
- King’s College London, London, United Kingdom
- Invicro, Ltd., London, United Kingdom
| | - Iain Sim
- King’s College London, London, United Kingdom
| | | | | | | | | | | | | | | | - Matt Wright
- King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark O’Neill
- King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
38
|
Kautzner J, Albenque JP, Natale A, Maddox W, Cuoco F, Neuzil P, Poty H, Getman MK, Liu S, Starek Z, Dukkipati SR, Colley BJ, Al-Ahmad A, Sidney DS, McElderry HT. A Novel Temperature-Controlled Radiofrequency Catheter Ablation System Used to Treat Patients With Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:352-363. [PMID: 33516712 DOI: 10.1016/j.jacep.2020.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES DIAMOND-AF (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation) was a prospective, multicenter, noninferiority, randomized trial that compared the safety and effectiveness of the DTA system versus those of a force-sensing RF ablation system (control) for the treatment of patients with drug-refractory, recurrent, symptomatic paroxysmal atrial fibrillation (AF). BACKGROUND Irrigated radiofrequency (RF) ablation catheters lose tissue temperature acuity, which is vital in assessing lesion formation. DiamondTemp Ablation (DTA) was designed to re-establish accurate tissue temperature measurements during ablation. METHODS A total of 482 patients with paroxysmal AF were randomized (239 DTA, 243 control) to undergo pulmonary vein isolation and were followed up at 23 sites. Patients were screened for disease progression, cardiac characteristics, and prior interventions. Primary endpoints were effectiveness (freedom from atrial arrhythmia recurrence) and safety (composite of procedure- and device-related serious adverse events). RESULTS The primary safety event rate was 3.3% in the DTA group versus 6.6% in the control group (p < 0.001 vs. 6.5% noninferiority margin). Primary effectiveness was met in 79.1% of DTA subjects and 75.7% of control subjects (p < 0.001 vs. -12.5% noninferiority margin). Secondary endpoint analysis found that off-drug effectiveness favored DTA compared with the control (142 [59.4%] vs. 120 [49.4%], respectively; p = 0.03). Total RF time and individual RF ablation duration were significantly shorter with less saline infused through the DTA catheter (p < 0.001). Both arms saw clinically meaningful improvements in quality of life at 12 months. CONCLUSIONS Safety and efficacy of the DTA system proved noninferior to force-sensing RF ablation in a paroxysmal AF population. Efficiencies were observed using DTA with shorter total RF times, individual RF ablation durations, and less saline infusion. (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation; NCT03334630).
Collapse
Affiliation(s)
- Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - William Maddox
- University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Frank Cuoco
- Trident Medical Center, Charleston, South Carolina, USA
| | | | - Herve Poty
- Clinique du Tonkin, Valleurbanne, France
| | | | - Shufeng Liu
- Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Zdenek Starek
- St. Anne's University Hospital, Brno, Czech Republic
| | | | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | | | | |
Collapse
|
39
|
Kim B, Kim S. Neural Network Based Contact Force Control Algorithm for Walking Robots. Sensors (Basel) 2021; 21:E287. [PMID: 33406701 DOI: 10.3390/s21010287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/04/2022]
Abstract
Walking algorithms using push-off improve moving efficiency and disturbance rejection performance. However, the algorithm based on classical contact force control requires an exact model or a Force/Torque sensor. This paper proposes a novel contact force control algorithm based on neural networks. The proposed model is adapted to a linear quadratic regulator for position control and balance. The results demonstrate that this neural network-based model can accurately generate force and effectively reduce errors without requiring a sensor. The effectiveness of the algorithm is assessed with the realistic test model. Compared to the Jacobian-based calculation, our algorithm significantly improves the accuracy of the force control. One step simulation was used to analyze the robustness of the algorithm. In summary, this walking control algorithm generates a push-off force with precision and enables it to reject disturbance rapidly.
Collapse
|
40
|
Takashima K, Ikeda Y, Yoshinaka K, Ohta M, Mori K, Toma N. Evaluation of Contact Force between Aneurysm Model and Coil for Embolization of Intracranial Aneurysms. J Neuroendovasc Ther 2020; 15:233-239. [PMID: 37501696 PMCID: PMC10370923 DOI: 10.5797/jnet.oa.2020-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/21/2020] [Indexed: 07/29/2023]
Abstract
Objective To ensure safe coil embolization for intracranial aneurysms, it is important to investigate the contact force between the coil and the aneurysm wall. However, it is unclear how the catheter tip position and the diameter of the secondary loop of the coil influence the contact force. In this study, we measured the contact force between a coil and an aneurysm biomodel under different conditions. Methods A commercially available coil was inserted through a microcatheter into a silicone rubber aneurysm model at a constant speed (1 mm/s) using an automatic stage, and the contact force between the coil and the aneurysm wall was measured by a force sensor attached on the aneurysm model. The inner diameter of the spherical aneurysm was 5 mm. The effects of varying the position of the catheter tip (near dome, center, near neck) and the diameter of the secondary coil (4.5 mm) were evaluated. Results When the catheter tip was inserted more deeply into the aneurysm (especially near the dome), the contact force increased. The contact force also increased as the secondary coil diameter was increased with the catheter tip near and in the center of the dome. Conclusion These results suggest that the catheter tip position and the secondary coil diameter affect the contact force. In particular, the contact force should be considered large with the catheter tip near the dome to ensure safe coil deployment.
Collapse
Affiliation(s)
- Kazuto Takashima
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Yuta Ikeda
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka, Japan
| | - Kiyoshi Yoshinaka
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan
| | - Makoto Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Koji Mori
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Naoki Toma
- Graduate School of Medicine, Mie University, Tsu, Mie, Japan
| |
Collapse
|
41
|
Pook C, Kuhn E, Singh A, Kovach J. Contact force ablation of accessory pathways in pediatric patients. J Cardiovasc Electrophysiol 2020; 32:370-375. [PMID: 33205493 DOI: 10.1111/jce.14817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contact force (CF) catheters provide feedback confirming adequate tissue contact for optimal lesion size and minimal complications. CF ablation catheters have resulted in decreased procedure times and improved outcomes for ablation of atrial fibrillation in adults. There is limited data evaluating CF use for accessory pathway (AP) ablation or in pediatric patients. The aim of our study was to compare a cohort who underwent AP ablation with a CF catheter to historical controls, evaluating for differences in procedure times, number of lesions, and outcomes. METHODS A retrospective chart review of CF ablation cases at Children's Wisconsin performed between June 2015 to April 2018 was compared to a historical control cohort of traditional radiofrequency (RF) ablations between June 2012 and June 2015. 43 patients with APs underwent 49 CF ablation procedures (18 males, 13.6 ± 3 years old) and a control cohort consisted of 77 procedures in 69 patients (38 males, 12.4 ± 4 years). RESULTS The groups did not differ significantly on procedure time (CF 2.01 ± 0.48 h, control 1.53 ± 0.48 h, p = .37), or total lesions administered (CF and control 7 ± 6 lesions, p = .89). CF cases showed a trend toward improvement in acute success (98% CF, 90% controls, p = .15) though with increased recurrence compared to controls (13% CF, 4.3% controls, p = .16), neither being statistically significant. CONCLUSION Our study suggests that ablation outcomes using CF are comparable to traditional RF ablation in pediatric patients with APs.
Collapse
Affiliation(s)
- Caitlin Pook
- Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Evelyn Kuhn
- Department of Business Intelligence and Data Warehousing, Children's Wisconsin, Wauwatosa, Wisconsin, USA
| | - Anoop Singh
- Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Joshua Kovach
- Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| |
Collapse
|
42
|
Kristiansen SB, Shafaq A, Tofig BJ, Gerdes C, Jensen HK, Kristensen J, Parner ET, Lukac P. Repeat pulmonary vein isolation in patients with atrial fibrillation: low ablation index is associated with increased risk of recurrent arrhythmia. SCAND CARDIOVASC J 2020; 55:29-34. [PMID: 33073633 DOI: 10.1080/14017431.2020.1831051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to investigate the predictors of recurrent arrhythmia after repeated pulmonary vein isolation (PVI) performed in the era of contact force without additional substrate ablation. One of the predictors studied, ablation index (AI), incorporates power, contact force, and time in a weighted formula and is reported to predict lesion size in animals. Design. Consecutive patients (n = 108) undergoing repeat PVI without additional substrate modification using a contact force sensing catheter were included retrospectively at a tertiary center. All ablation points were analyzed offline. A new variable, normalized AI (AI corrected for the location of the lesion-anterior vs. posterior) was calculated. The patients were systematically followed with clinical visit and 12-lead ECG as well as review of the regional electronic patient files at 3 and 12 months after the procedure with 5-day Holter at 12 months. Results. Electrical reconnection to at least one pulmonary vein (PV) was seen in 97% of the patients. The recurrence rate was 35%. There was no recurrence in patients with nAI above 1.15 (n = 26). Patients with electrical reconnection of up to two PVs had a higher risk of recurrence compared with patients having electrical reconnection of three or four PVs (p = .003), and this risk was especially high in patients with persistent atrial fibrillation (69 [39-91]%). Conclusions. The risk of recurrence is higher in patients with ablations performed with low levels of AI and in patients with reconnection to up to two PVs. Our data may indicate the need for higher target levels of AI during repeat PVI than normally used during de-novo PVI.
Collapse
Affiliation(s)
| | - Ajmal Shafaq
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bawer J Tofig
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik T Parner
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
43
|
Ding L, Xian M, Zhang Q. Prediction of casing wear depth and residual strength in highly-deviated wells based on modeling and simulation. Sci Prog 2020; 103:36850420969577. [PMID: 33225844 PMCID: PMC10450893 DOI: 10.1177/0036850420969577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Casing wear is a serious problem in highly-deviated wells because serious wear will lead to casing deformation, drilling tool sticking and failure of subsequent operations. The purpose of this paper is to predict casing wear depth and evaluate its effect on casing strength degradation in highly-deviated well drilling operation. Special attention has been given to the algorithm to achieve the prediction and evaluation. The effect of tool joint on contact force distribution is considered in contact force model. Then a wear depth prediction model and its solution method are proposed based on crescent-shaped wear morphology and wear-efficiency model. Besides, strength degradation of worn casing is analyzed in bipolar coordinate system and the model is verified by finite element method. Therefore, the technology of casing wear prediction and residual strength evaluation is completed systematically. Then, to apply casing wear prediction and residual strength evaluation technologies to an actual highly-deviated well, casing wear experiment and friction coefficient experiment are carried out to obtain wear coefficient and friction coefficient. Finally, based on the established models as well as experimental results, the distribution of casing wear is predicted and residual strength is evaluated. The method presented in this paper will contribute greatly to casing wear prediction and evaluation in highly-deviated wells.
Collapse
Affiliation(s)
- Liangliang Ding
- School of Mechatronic Engineering, Southwest Petroleum University, Chengdu, Sichuan, China
- State Key Laboratory of Oil and Gas Reservoir Geology and Exploitation, Southwest Petroleum University, Chengdu, China
| | - Miao Xian
- School of Mechatronic Engineering, Southwest Petroleum University, Chengdu, Sichuan, China
| | - Qiang Zhang
- School of Mechatronic Engineering, Southwest Petroleum University, Chengdu, Sichuan, China
- State Key Laboratory of Oil and Gas Reservoir Geology and Exploitation, Southwest Petroleum University, Chengdu, China
| |
Collapse
|
44
|
Scardulla F, D’Acquisto L, Colombarini R, Hu S, Pasta S, Bellavia D. A Study on the Effect of Contact Pressure during Physical Activity on Photoplethysmographic Heart Rate Measurements. Sensors (Basel) 2020; 20:E5052. [PMID: 32899540 PMCID: PMC7570982 DOI: 10.3390/s20185052] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Heart rate (HR) as an important physiological indicator could properly describe global subject's physical status. Photoplethysmographic (PPG) sensors are catching on in field of wearable sensors, combining the advantages in costs, weight and size. Nevertheless, accuracy in HR readings is unreliable specifically during physical activity. Among several identified sources that affect PPG recording, contact pressure (CP) between the PPG sensor and skin greatly influences the signals. METHODS In this study, the accuracy of HR measurements of a PPG sensor at different CP was investigated when compared with a commercial ECG-based chest strap used as a test control, with the aim of determining the optimal CP to produce a reliable signal during physical activity. Seventeen subjects were enrolled for the study to perform a physical activity at three different rates repeated at three different contact pressures of the PPG-based wristband. RESULTS The results show that the CP of 54 mmHg provides the most accurate outcome with a Pearson correlation coefficient ranging from 0.81 to 0.95 and a mean average percentage error ranging from 3.8% to 2.4%, based on the physical activity rate. CONCLUSION Authors found that changes in the CP have greater effects on PPG-HR signal quality than those deriving from the intensity of the physical activity and specifically, the individual best CP for each subject provided reliable HR measurements even for a high intensity of physical exercise with a Bland-Altman plot within ±11 bpm. Although future studies on a larger cohort of subjects are still needed, this study could contribute a profitable indication to enhance accuracy of PPG-based wearable devices.
Collapse
Affiliation(s)
- Francesco Scardulla
- Department of Engineering, University of Palermo, 90128 Palermo, Italy; (L.D.); (R.C.); (S.P.)
| | - Leonardo D’Acquisto
- Department of Engineering, University of Palermo, 90128 Palermo, Italy; (L.D.); (R.C.); (S.P.)
| | - Raffaele Colombarini
- Department of Engineering, University of Palermo, 90128 Palermo, Italy; (L.D.); (R.C.); (S.P.)
| | - Sijung Hu
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK;
| | - Salvatore Pasta
- Department of Engineering, University of Palermo, 90128 Palermo, Italy; (L.D.); (R.C.); (S.P.)
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, via Tricomi n.5, 90127 Palermo, Italy;
| |
Collapse
|
45
|
Calkins H. Important Differences Exist Between Atrial Fibrillation and Atrial Flutter in Atrial Remodeling. J Am Coll Cardiol 2020; 76:389-390. [PMID: 32703508 DOI: 10.1016/j.jacc.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
|
46
|
Gupta D. Noninvasive assessment of durability of ablation lesions with magnetic resonance imaging: Are we there yet? J Cardiovasc Electrophysiol 2020; 31:2582-2583. [PMID: 32648314 DOI: 10.1111/jce.14661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dhiraj Gupta
- Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
47
|
Uetake S, Miyauchi Y, Mitsuishi T, Maruyama M, Seino Y, Shimizu W. Re-definition of blanking period in radiofrequency catheter ablation of atrial fibrillation in the contact force era. J Cardiovasc Electrophysiol 2020; 31:2363-2370. [PMID: 32608072 DOI: 10.1111/jce.14643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Early recurrence (ER) of atrial fibrillation (AF) is defined as the recurrence of atrial tachyarrhythmias within 3 months after AF ablation, however, this definition is based on data from the era of radiofrequency catheter ablation (RFCA), without contact force (CF) technology. We investigated the significance of ER as a risk factor for late recurrence (LR) in paroxysmal AF (PAF) patients treated with CF and non-CF-guided ablation. METHODS AND RESULTS We studied 395 patients with PAF who underwent RFCA. Of these, 97 patients underwent RFCA without-CF technology (non-CF group) and 298 underwent with CF technology (CF group). Over a 2-year postablation follow-up period, LR occurred in 54 (55.7%) patients in the non-CF group, and in 105 (35.2%) patients in the CF group. ER had a more significant relationship with LR in the CF group, and all patients in the CF group with ER in the third month developed LR. CONCLUSION PAF patients with ER who have undergone CF-guided ablation have a greater risk of LR than those who have undergone non-CF-guided ablation. ER in the third month after CF-guided ablation may indicate an absolute risk of LR. Blanking period could be defined as 2 months in the CF era.
Collapse
Affiliation(s)
- Shunsuke Uetake
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Tatsuya Mitsuishi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Yoshihiko Seino
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
48
|
Aizer A, Qiu JK, Cheng AV, Wu PB, Barbhaiya CR, Jankelson L, Linton P, Bernstein SA, Park DS, Holmes DS, Chinitz LA. Rapid pacing and high-frequency jet ventilation additively improve catheter stability during atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:1678-1686. [PMID: 32314841 DOI: 10.1111/jce.14507] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Catheter stability during atrial fibrillation ablation is associated with higher ablation success rates. Rapid cardiac pacing and high-frequency jet ventilation (HFJV) independently improve catheter stability. Simultaneous modulation of cardiac and respiratory motion has not been previously studied. The objective of this study was to determine the effect of simultaneous heart rate and respiratory rate modulation on catheter stability. METHODS Forty patients undergoing paroxysmal atrial fibrillation ablation received ablation lesions at 15 prespecified locations (12 left atria, 3 right atria). Patients were randomly assigned to undergo rapid atrial pacing for either the first or the second half of each lesion. Within each group, half of the patients received HFJV and the other half standard ventilation. Contact force and ablation data for all lesions were compared among the study groups. Standard deviation of contact force was the primary endpoint defined to examine contact force variability. RESULTS Lesions with no pacing and standard ventilation had the greatest contact force standard deviation (5.86 ± 3.08 g), compared to lesions with pacing and standard ventilation (5.45 ± 3.28 g; P < .01) or to lesions with no pacing and HFJV (4.92 ± 3.00 g; P < .01). Lesions with both pacing and HFJV had the greatest reduction in contact force standard deviation (4.35 ± 2.81 g; P < .01), confirming an additive benefit of each maneuver. Pacing and HFJV together was also associated with a reduction in the proportion of lesions with excessive maximum contact force (P < .001). DISCUSSION Rapid pacing and HFJV additively improve catheter stability. Simultaneous pacing with HFJV further improves catheter stability over pacing or HFJV alone to optimize ablation lesions.
Collapse
Affiliation(s)
- Anthony Aizer
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Jessica K Qiu
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Austin V Cheng
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Patrick B Wu
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Chirag R Barbhaiya
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Lior Jankelson
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Patrick Linton
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Scott A Bernstein
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - David S Park
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Douglas S Holmes
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Larry A Chinitz
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| |
Collapse
|
49
|
Pak HN, Park JW, Yang SY, Yu HT, Uhm JS, Joung B, Lee MH, Kim TH. A mesh-type flexible tip catheter vs a contact force catheter for catheter ablation of atrial fibrillation: A prospective nonrandomized 1:1 matched study. J Cardiovasc Electrophysiol 2020; 31:1279-1288. [PMID: 32270578 DOI: 10.1111/jce.14484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mesh-type flexible tip (MFT) catheters allow clinicians to safely generate large radiofrequency lesions during catheter ablation of atrial fibrillation (AF), while contact force (CF) catheters provide better catheter-tissue contact. We compared the clinical outcomes of catheter ablation of AF using MFT and CF catheters in a prospective, nonrandomized manner. METHODS We prospectively assigned 217 patients with AF (paroxysmal AF 73.5%; male 69.1%; 59.9 ± 10.7 years old) at a 1:1 ratio to ablation with MFT catheters (FlexAbility) or CF catheters (TactiCath). The primary endpoint was AF recurrence after a single procedure; the secondary endpoint was a response to antiarrhythmic drugs. RESULTS After a mean follow-up of 22.3 ± 4.4 months, the clinical recurrence rate did not significantly differ between the two study groups (29.7% vs 30.2%; P = .941) (log-rank P = .838). The recurrence rate for atrial tachycardias (30.3% vs 9.7%; P = .035) and cardioversion rates (8.1% vs 1.9%; P = .024) were higher in the MFT group than CF group. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 57.7% of the MFT group and 40.6% of the CF group (P = .010). No significant difference was found in the major complication rates between the two groups (0.9% vs 5.7%), although the ablation time was significantly longer in the MFT group (4192.1 ± 1080.2 vs 3583.8 ± 977.2 seconds; P < .001). CONCLUSION MFT and CF catheters had similar effectiveness in achieving AF rhythm control during catheter ablation, and there was no significant difference between the two catheters with regard to overall safety.
Collapse
Affiliation(s)
- Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
50
|
Li Y, Shen Y, Xing Q. Study on Transient Contact-Impact Characteristics and Driving Capability of Piezoelectric Stack Actuator. Sensors (Basel) 2019; 20:E233. [PMID: 31906145 PMCID: PMC6983117 DOI: 10.3390/s20010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
The transient contact-impact mechanism and driving capability of the piezoelectric stack actuator is analyzed using both experimental and theoretical methods. An experimental setup and its corresponding measurement approaches for the transient responses are designed. The launch range of the object resulting from the first contact-impact is measured through laser doppler vibrometer and the motion process is captured by high-speed camera. Experimental results illustrate that the launch range increases firstly and decreases subsequently as the frequency of the sine driving voltage increases. Meanwhile, considering the local viscoelastic contact deformation, a theoretical methodology including the mechanics model for the driving process is proposed. Based on the Lagrange equations of second kind, the governing equation of the driving system is derived. Transient responses are calculated using the fourth-order Runge-Kutta integration method. Contact forces and Poisson's coefficient of restitution are calculated by the proposed theoretical method. The results of launch range show that the theoretical solutions have a good agreement with the experimental data. The peak value of contact force increases firstly and decreases subsequently with the increase of voltage frequency. In addition, the coefficient of restitutions is roughly 0.9 when f is greater than 3.5 kHz.
Collapse
Affiliation(s)
| | - Yunian Shen
- Department of Mechanics and Engineering Science, School of Science, Nanjing University of Science and Technology, Nanjing 210094, China; (Y.L.); (Q.X.)
| | | |
Collapse
|