scholarly journals Evolution of Force Sensing Technologies

2017 ◽  
Vol 6 (2) ◽  
pp. 75
Author(s):  
Dipen Shah ◽  
Keyword(s):  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Contact Force ◽  
Standard Of Care ◽  
Lesion Size ◽  
Assessment Tools ◽  
Force Sensing ◽  
Target Tissue ◽  
Catheter Tip

In order to improve the procedural success and long-term outcomes of catheter ablation techniques for atrial fibrillation (AF), an important unfulfilled requirement is to create durable electrophysiologically complete lesions. Measurement of contact force (CF) between the catheter tip and the target tissue can guide physicians to optimise both mapping and ablation procedures. Contact force can affect lesion size and clinical outcomes following catheter ablation of AF. Force sensing technologies have matured since their advent several years ago, and now allow the direct measurement of CF between the catheter tip and the target myocardium in real time. In order to obtain complete durable lesions, catheter tip spatial stability and stable contact force are important. Suboptimal energy delivery, lesion density/contiguity and/or excessive wall thickness of the pulmonary vein-left atrial (PV-LA) junction may result in conduction recovery at these sites. Lesion assessment tools may help predict and localise electrical weak points resulting in conduction recovery during and after ablation. There is increasing clinical evidence to show that optimal use of CF sensing during ablation can reduce acute PV re-conduction, although prospective randomised studies are desirable to confirm long-term favourable clinical outcomes. In combination with optimised lesion assessment tools, contact force sensing technology has the potential to become the standard of care for all patients undergoing AF catheter ablation.

scholarly journals Evolution of Force Sensing Technologies

2017 ◽  
Vol 6 (2) ◽  
pp. 75 ◽  
Author(s):  
Dipen Shah ◽  
Keyword(s):  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Contact Force ◽  
Standard Of Care ◽  
Lesion Size ◽  
Assessment Tools ◽  
Force Sensing ◽  
Target Tissue ◽  
Catheter Tip

In order to improve the procedural success and long-term outcomes of catheter ablation techniques for atrial fibrillation (AF), an important unfulfilled requirement is to create durable electrophysiologically complete lesions. Measurement of contact force (CF) between the catheter tip and the target tissue can guide physicians to optimise both mapping and ablation procedures. Contact force can affect lesion size and clinical outcomes following catheter ablation of AF. Force sensing technologies have matured since their advent several years ago, and now allow the direct measurement of CF between the catheter tip and the target myocardium in real time. In order to obtain complete durable lesions, catheter tip spatial stability and stable contact force are important. Suboptimal energy delivery, lesion density/contiguity and/or excessive wall thickness of the pulmonary vein-left atrial (PV-LA) junction may result in conduction recovery at these sites. Lesion assessment tools may help predict and localise electrical weak points resulting in conduction recovery during and after ablation. There is increasing clinical evidence to show that optimal use of CF sensing during ablation can reduce acute PV re-conduction, although prospective randomised studies are desirable to confirm long-term favourable clinical outcomes. In combination with optimised lesion assessment tools, contact force sensing technology has the potential to become the standard of care for all patients undergoing AF catheter ablation.

scholarly journals Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias

2018 ◽  
Vol 4 (6) ◽  
pp. 707-723 ◽  
Author(s):  
Nilshan Ariyarathna ◽  
Saurabh Kumar ◽  
Stuart P. Thomas ◽  
William G. Stevenson ◽  
Gregory F. Michaud
Keyword(s):  
Catheter Ablation ◽  
Contact Force ◽  
Cardiac Arrhythmias ◽  
Force Sensing

scholarly journals 10-year clinical outcomes after radiofrequency catheter ablation for atrial fibrillation. A single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.F Alderete Martinez ◽  
S Shizuta ◽  
F Yoneda ◽  
S Nishiwaki ◽  
M Tanaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Adverse Events ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Radiofrequency Catheter Ablation ◽  
Rank Test ◽  
Log Rank Test

Abstract Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is becoming a routine procedure to treat patients with drug-refractory symptomatic AF. However, data regarding very long-term clinical outcomes is limited. The aim of the present study was to evaluate the 10-year clinical outcomes of patients who underwent RFCA for paroxysmal and persistent AF. Methods We retrospectively enrolled 503 consecutive patients (mean age 66,9±9,51 years; 71,6% male) who underwent RFCA for drug-refractory symptomatic AF between February 2004 and June 2011. Follow-up information was obtained using medical records and/or telephonic interviews with the patient, relatives and/or referring physicians. Results Among 503 patients enrolled in this study, 362 had paroxysmal atrial fibrillation (PAF) and 141 had persistent atrial fibrillation (PeAF) (72% and 28%, respectively). Mean follow-up was 8,84±3,05 years. The 10-year event-free rate for recurrent atrial tachyarrhythmia (AT) after the first procedure was 44,5% (49,4% for PAF vs 31,9% for PeAF; p=0,002 by log-rank test) and 81,9% after the last procedure (87,3% for PAF and 67,9% for PeAF; p≤0,001 by log-rank test). AT recurrence was observed most commonly during the first 12 months of the initial procedure (56%), with only 18% of them occurring after 60 months. Multivariate analysis revealed that persistent AF (hazard ratio=1,366; 95% confidence interval 1,058–1,76; p=0,017) and duration of AF >5 years (hazard ratio=1,357; 95% confidence interval 1,064–1,732; p=0,005) were independent risk factors for AT recurrence. Regarding adverse events, there were 24 (4,8%) hospitalizations for acute decompensated heart failure, 20 (4%) ischemic strokes and 14 (2,8%) bleeding complications requiring hospital admissions. Patients taking oral anticoagulation and antiarrhythmic drugs at the end of the study accounted for 32,8% and 16,7% respectively. Conclusions RFCA for AF provided favorable results in terms of arrhythmia event-free survival in long-term follow-up with better results in patients with paroxysmal AF. Persistent AF and long-standing AF (beyond 5 years) were associated with AT recurrence. Despite the large number of patients who discontinued oral anticoagulation, thromboembolic adverse events were rare. FUNDunding Acknowledgement Type of funding sources: None.

P2431Stay on the safe side: in-silico assessment of ablation protocols to prevent steam pops during radiofrequency ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Petras ◽  
M Echeverria Ferrero ◽  
M Leoni ◽  
J M Guerra ◽  
J Jansson ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Contact Force ◽  
In Silico ◽  
Lesion Size ◽  
Physical Parameters ◽  
Strong Impact ◽  
Human Atrium ◽  
Saline Irrigation ◽  
Catheter Tip ◽  
Tissue Characteristics

Abstract Background Steam pops (SP) are among the most serious complications of radiofrequency ablation (RFA) due to its potential to cause myocardial tear or tamponade. SP occur when the tissue overheats, causing its water content to transform into steam and explode. Ablation parameters are critical in order to obtain an optimal lesion size while avoiding the occurrence of SP. However, the interaction between ablation settings and the physical parameters that predispose to SP occurrence during irrigated RFA are not fully understood. Purpose To characterize regularly used ablation protocols by means of a computational model, in order to achieve optimal lesion size while avoiding SP occurrence. Methods The in-silico evaluation is performed using our previously developed computational irrigated RFA model. Our model takes into account the blood-saline interaction as well as the mechanical deformation of the tissue due to the contact with the catheter tip. We test the effects of applied power and contact force on two catheter tip designs (spherical and cylindrical) and two substrates, simulated human atrium and ventricle, during 30 sec applications. A fixed blood flow and catheter-tip saline irrigation (0.5m/s and 17mL/min, respectively) are considered. We simulate human tissue by using the biophysical, mechanical and physiological properties found in the literature. SP occurrence is predicted when the temperature within the tissue reaches 100°C. Results Based on the interaction of power and contact force, four risk maps are constructed encompassing the two catheter-tip designs and the two simulated tissues. The maps allow the identification of those ablation protocols (contact force and delivered power) that can potentially result on SP. They correspond to that area of critical temperature values where the temperature within the tissue reach the established criteria for SP occurrence. We also present the lesion size dimensions of ablation protocols that avoid the formation of steam pops. Conclusion Our results indicate that the applied power has a strong impact in the formation of SP for a cylindrical catheter, while a combination of contact force and power is important to avoid risks in the case of the spherical catheter tip. The tissue characteristics do not affect significantly the SP occurrence, in agreement with experimental literature. However, the resulting lesion size appears to be larger in the simulated human atrium in comparison to the simulated human ventricle. Acknowledgement/Funding BERC 2018-2021, SEV-2017-0718

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