A Novel Tool for Improved Control and Maneuverability in Pediatric Cardiac Catheter Ablation Procedures

2020 ◽  
Author(s):  
Paige N. Mass ◽  
Rohan N. Kumthekar ◽  
Charles I. Berul ◽  
Justin D. Opfermann
Keyword(s):  
Catheter Ablation ◽  
Tensile Testing ◽  
Pediatric Population ◽  
Clinical Use ◽  
Cardiac Ablation ◽  
Average Force ◽  
Cardiac Catheter ◽  
Catheter Tip ◽  
Treatment Of Arrhythmias ◽  
Manual Manipulation

Abstract Cardiac ablation catheters commonly used for the diagnosis and treatment of arrhythmias are small in diameter and require extensive finger grip and dexterity for safe maneuverability during procedures. This is especially important in the pediatric population where the cardiac structures are smaller and potentially more variable as a result of congenital anatomic anomalies. We developed a novel catheter grip accessory tool for improved control and maneuverability of cardiac ablation catheters. Mechanical testing of the tool demonstrated it could grip the catheter with an average force of 0.031 kN and transfer an average torque of 0.0392 N-m before slipping, both well above forces experienced in normal clinical use. During tensile testing, the tool fractured at an average force of 0.554 kN. At the point of failure, testing found that the electrical conduction and resistance of the catheter remained unchanged. In simulated use testing, the tool was able to translate torque more accurately to the catheter tip compared to manual manipulation of the catheter. This novel tool has the potential to reduce physician muscle exertion in ablation procedures and increase the safety profile when manipulating catheters within the heart.

scholarly journals A Soft Resistive Sensor with a Semicircular Cross-Sectional Channel for Soft Cardiac Catheter Ablation

Sensors ◽  
2021 ◽  
Vol 21 (12) ◽  
pp. 4130
Author(s):  
Eric Rasmussen ◽  
Daniel Guo ◽  
Vybhav Murthy ◽  
Rachit Mishra ◽  
Cameron Riviere ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Liquid Metal ◽  
Force Feedback ◽  
Applied Force ◽  
Medical Community ◽  
Soft Robotics ◽  
Soft Sensors ◽  
Cross Sectional ◽  
Cardiac Catheter ◽  
Specific Loading

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.

Non-fluoroscopic cardiac ablation of neonates with CHD

2016 ◽  
Vol 27 (3) ◽  
pp. 592-596 ◽  
Author(s):  
Amee M. Bigelow ◽  
Brandon S. Arnold ◽  
Gregory C. Padrutt ◽  
John M. Clark
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Tricuspid Valve ◽  
Congenital Heart ◽  
Current Practice ◽  
Pulmonary Atresia ◽  
Intact Ventricular Septum ◽  
Cardiac Ablation

AbstractIn current practice, children with anatomically normal hearts routinely undergo fluoroscopy-free ablations. Infants and children with congenital heart disease (CHD) represent the most difficult population to perform catheter ablation without fluoroscopy. We report two neonatal patients with CHD in whom cardiac ablations were performed without fluoroscopy. The first infant had pulmonary atresia with intact ventricular septum with refractory supraventricular tachycardia, and the second infant presented with Ebstein’s anomaly of the tricuspid valve along with persistent supraventricular tachycardia. Both patients underwent uncomplicated, successful ablation without recurrence of arrhythmias. These cases suggest that current approaches to minimising fluoroscopy may be useful even in challenging patients such as neonates with CHD.

scholarly journals Conceptus Radiation Dose and Risk From Cardiac Catheter Ablation Procedures

Circulation ◽  
2001 ◽  
Vol 104 (8) ◽  
pp. 893-897 ◽  
Author(s):  
John Damilakis ◽  
Nicholas Theocharopoulos ◽  
Kostas Perisinakis ◽  
Emmanouel Manios ◽  
Panayiotis Dimitriou ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Dose ◽  
Cardiac Catheter

scholarly journals Electroporation and its Relevance for Cardiac Catheter Ablation

2018 ◽  
Vol 4 (8) ◽  
pp. 977-986 ◽  
Author(s):  
Fred H.M. Wittkampf ◽  
René van Es ◽  
Kars Neven
Keyword(s):  
Catheter Ablation ◽  
Cardiac Catheter

Probabilistic guidance for catheter tip motion in cardiac ablation procedures

2018 ◽  
Vol 47 ◽  
pp. 1-14 ◽  
Author(s):  
Mihaela AM Constantinescu ◽  
Su-Lin Lee ◽  
Sabine Ernst ◽  
Apit Hemakom ◽  
Danilo Mandic ◽  
...  
Keyword(s):  
Cardiac Ablation ◽  
Catheter Tip

Design and Evaluation of a Passive Constant Force Mechanism for a Cardiac Ablation Catheter

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Werner W. P. J. van de Sande ◽  
Awaz Ali ◽  
Giuseppe Radaelli
Keyword(s):  
Contact Force ◽  
Effective Range ◽  
Constant Force ◽  
Ablation Catheter ◽  
Cardiac Ablation ◽  
Element Analysis ◽  
Average Force ◽  
And Performance ◽  
Force Mechanism ◽  
Constant Force Mechanism

Abstract Contact force management has been proven to have a positive effect on the outcome of cardiac ablation procedures. However, no method exists that allows maintaining a constant contact force within a required and effective range. This work aims to develop and evaluate such a constant force mechanism for use in an ablation catheter. A passive constant force mechanism was designed based on a tape loop. The tape loop consists of two tapered springs that work in parallel. A finite element analysis was carried out to verify the behavior and performance of the design. A design based on requirements for a constant force ablation tip showed an average force of about 7.8×10−2 N±8×10−3 N over 20 mm in simulation. A scaled prototype was built and evaluated to prove the validity of the concept; this prototype provides an average force of 1.3×10−1 N±1.6×10−2 N over 35 mm. The mechanism allows for controlled delivery of contact force within a desired and effective range. Based on these findings, it can be concluded that the approach is successful but needs to be optimized for future applications. Being able to control the delivery of contact force in a constant range may increase the effectivity of cardiac ablation procedures and improve clinical outcomes.

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

EP Europace ◽  
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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