Electroporation and its Relevance for Cardiac Catheter Ablation

The field of soft robotics has attracted the interest of the medical community due to the ability of soft elastic materials to traverse the abnormal environment of the human body. However, sensing in soft robotics has been challenging due to the sensitivity of soft sensors to various loading conditions and the nonlinear signal responses that can arise under extreme loads. Ideally, soft sensors should provide a linear response under a specific loading condition and provide a different response for other loading directions. With these specifications in mind, our team created a soft elastomeric sensor designed to provide force feedback during cardiac catheter ablation surgery. Analytical and computational methods were explored to define a relationship between resistance and applied force for a semicircular, liquid metal filled channel in the soft elastomeric sensor. Pouillet’s Law is utilized to calculate the resistance based on the change in cross-sectional area resulting from various applied pressures. FEA simulations were created to simulate the deformation of the sensor under various loads. To confirm the validity of these simulations, the elastomer was modeled as a neo-Hookean material and the liquid metal was modeled as an incompressible fluid with negligible shear modulus under uniaxial compression. Results show a linearly proportional relationship between the resistance of the sensor and the application of a uniaxial force. Altering the direction of applied force results in a quadratic relationship between total resistance and the magnitude of force.

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Conceptus Radiation Dose and Risk From Cardiac Catheter Ablation Procedures

Circulation ◽

10.1161/hc5790.094909 ◽

2001 ◽

Vol 104 (8) ◽

pp. 893-897 ◽

Cited By ~ 70

Author(s):

John Damilakis ◽

Nicholas Theocharopoulos ◽

Kostas Perisinakis ◽

Emmanouel Manios ◽

Panayiotis Dimitriou ◽

...

Keyword(s):

Catheter Ablation ◽

Radiation Dose ◽

Cardiac Catheter

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Cathether contact geometry affects lesion formation in radio-frequency cardiac catheter ablation

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society ◽

10.1109/iembs.2011.6090046 ◽

2011 ◽

Cited By ~ 1

Author(s):

Neal P. Gallagher ◽

Elise C. Fear ◽

Edward J. Vigmond ◽

Israel A. Byrd

Keyword(s):

Catheter Ablation ◽

Radio Frequency ◽

Contact Geometry ◽

Lesion Formation ◽

Cardiac Catheter

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P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought?

EP Europace ◽

10.1093/europace/euaa162.324 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Bruce ◽

S Rogers ◽

K Saraf ◽

G Kirkwood ◽

N Kirkland ◽

...

Keyword(s):

Catheter Ablation ◽

Femoral Vein ◽

Accessory Pathway ◽

Significant Proportion ◽

Anticoagulation Therapy ◽

Vena Cava ◽

Iliac Vein ◽

P Value ◽

Cardiac Catheter ◽

Vein Thrombosis

Abstract Funding Acknowledgements Bristol-Myers Squibb Background Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad. As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified. Purpose To determine the incidence of DVT after right sided cardiac catheter ablation. Methods We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control. Result At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing. Conclusion We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation. Abstract Figure. Acute thrombus in the femoral vein

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Gaps in patient-reported outcome measures in randomized clinical trials of cardiac catheter ablation: a systematic review

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcaa022 ◽

2020 ◽

Vol 6 (4) ◽

pp. 234-242

Author(s):

Yang Chen ◽

Myura Nagendran ◽

Manuel Gomes ◽

Peter V Wharton ◽

Rosalind Raine ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Catheter Ablation ◽

Outcome Measures ◽

Comparative Effectiveness ◽

Randomized Clinical Trials ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Cardiac Catheter ◽

Patient Reported

Abstract The aim of this systematic review was to evaluate randomized clinical trials (RCTs) of cardiac catheter ablation (CCA) and to assess the prevalence, characteristics and reporting standards of clinically relevant patient-reported outcome measures (PROMs). Electronic database searches of Medline, Embase, CENTRAL, and the WHO Trial Registry were conducted in March 2019. The study protocol was registered on PROSPERO (CRD42019133086). Of 7125 records identified, 237 RCTs were included for analysis, representing 35 427 patients with a mean age of 59 years. Only 43 RCTs (18%) reported PROMs of which 27 included a generic PROM that measured health-related quality of life (HRQL) necessary to conduct comparative effectiveness research. There was notable under-representation of certain patient groups—only 31% were women and only 8% were of non-Caucasian ethnicity, in trials which reported such data. The reporting standard of PROMs was highly variable with 8–62% adherence against CONSORT PRO-specific items. In summary, PROMs play a crucial role in determining the clinical and cost-effectiveness of treatments which primarily offer symptomatic improvement, such as CCA. Their underuse significantly limits evaluation of the comparative effectiveness of treatments. Using CCA as an exemplar, there are additional issues of infrequent assessment, poor reporting and under-representation of many population groups. Greater use of PROMs, and specifically validated HRQL questionnaires, is paramount in giving patients a voice in studies, generating more meaningful comparisons between treatments and driving better patient-centred clinical and policy-level decision-making.

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