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Catheter Navigation (catheter + navigation)
Selected AbstractsSteerable Sheath Catheter Navigation for Ablation of Atrial Fibrillation: A Case-Control StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2008CHRISTOPHER PIORKOWSKI M.D. Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath. Methods and Results: In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow-up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 ± 9 vs 41 ± 4 W; P < 0.0005) and total RF energy delivery (97,498 vs 111,864 J; P < 0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P < 0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success. Conclusions: An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%. [source] Dynamic Registration of Preablation Imaging With a Catheter Geometry to Guide Ablation in a Swine Model: Validation of Image Integration and Assessment of Catheter Navigation AccuracyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010J. JASON WEST M.D. Image Integration with a Catheter Mapping System.,Background: Catheter ablation of atrial and ventricular tachyarrhythmia involves anatomically based cardiac ablation strategies. CT and MRI images provide the most detailed cardiac anatomy available. Integration of these images into a mapping system should produce detailed and accurate models suitable to guide ablation. Objective: The purpose of this study was to validate and assess the accuracy of a novel CT and MRI image integration algorithm designed to facilitate catheter navigation and ablation. Methods: Using a lateral thoracotomy, markers were sutured to the epicardial surface of each cardiac chamber in 12 swine. Detailed CT/MRI anatomy was imported into the mapping system. The CT/MRI image was then integrated with a detailed catheter geometry of the relevant chamber using a new image integration algorithm. The epicardial markers, identified from the CT/MRI images, were then displayed on the surface of the integrated image. Guided only by the integrated CT/MRI, a single RF lesion was directed at the corresponding endocardial site for each epicardial marker. At autopsy, the distance from the endocardial RF lesion to the target site was assessed. Results: The mean position error (CT/MRI) for the left atrium was 2.5 ± 2.4 mm/5.1 ± 3.9 mm, for the right atrium 6.2 ± 6.5 mm/4.3 ± 2.2 mm, for the right ventricle 6.2 ± 4.3 mm/6.6 ± 5.3 mm, and for the left ventricle 4.7 ± 3.4 mm/3.1 ± 2.7 mm. There was no cardiac perforation or tamponade. Conclusion: CT and MRI images can be effectively utilized for catheter navigation when integrated into a mapping system. This novel registration module with dynamic registration provides effective guidance for ablation. (J Cardiovasc Electrophysiol, Vol. 21, pp. 81,87, January 2010) [source] Steerable Sheath Catheter Navigation for Ablation of Atrial Fibrillation: A Case-Control StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2008CHRISTOPHER PIORKOWSKI M.D. Background: Lack of stable access to all desired ablation target sites is one of the limitations for efficacious circumferential left atrial (LA) pulmonary vein (PV) ablation. Targeting that, new catheter navigation technologies have been developed. The aim of this study was to describe atrial fibrillation (AF) mapping and ablation using manually controlled steerable sheath catheter navigation and to compare it against an ablation approach with a nonsteerable sheath. Methods and Results: In this case-control-analysis 245 consecutive patients (controls) treated with circumferential left atrial PV ablation were matched with 105 subsequently consecutive patients (cases) ablated with a similar line concept but mapping and ablation performed with a manually controlled steerable sheath. One hundred sixty-six patients were selected to be included into 83 matched patient pairs. Ablation success was measured with serial 7-day Holter electrocardiograms. Patients ablated with the steerable sheath showed an increase in the success rate (freedom from AF) from 56% to 77% (P = 0.009) after a single procedure and 6 months of follow-up. With respect to procedural data no difference could be found for procedure time, fluoroscopy time, irradiation dose, and radiofrequency (RF) burning time. With the steerable sheath mean procedural RF power (33 ± 9 vs 41 ± 4 W; P < 0.0005) and total RF energy delivery (97,498 vs 111,864 J; P < 0.005) were significantly lower and the rate of complete PV isolation significantly increased from 10% to 52% (P < 0.0005). The complication rate was the same in both groups. Among different arrhythmia, procedure, and patient characteristics, the lack of early postinterventional arrhythmia recurrences was the only but powerful predictor for long-term ablation success. Conclusions: An AF mapping and ablation approach solely using a manually controlled steerable sheath for catheter navigation improved the outcome of circumferential left atrial PV ablation at similar intervention times and similar complication rates. The 6-month success rate after a single LA intervention increased from 56% to 77%. [source] Skeleton-based active catheter navigationTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2009Yili Fu Abstract Background The emergence of the active catheter has prompted the development of catheterization in minimally invasive surgery. However, it is still operated using only the physician's vision; information supplied by the guiding image and tracking sensors has not been fully utilized. Methods In order to supply the active catheter with more useful information for automatic navigation, we extract the skeleton of blood vessels by means of an improved distance transform method, and then present the crucial geometric information determining navigation. With the help of tracking sensors' position and pose information, two operations, advancement in the proximal end and direction selection in the distal end, are alternately implemented to insert the active catheter into a target blood vessel. Results The skeleton of the aortic arch reconstructed from slice images is extracted fast and automatically. A navigation path is generated on the skeleton by manually selecting the start and target points, and smoothed with the cubic cardinal spline curve. Crucial geometric information determining navigation is presented, as well as requirements for the catheter entering the target blood vessel. Using a shape memory alloy active catheter integrated with magnetic sensors, an experiment is carried out in a vascular model, in which the catheter is successfully inserted from the ascending aorta, via the aortic arch, into the brachiocephalic trunk. Conclusions The navigation strategy proposed in this paper is feasible and has the advantage of increasing the automation of catheterization, enhancing the manoeuvrability of the active catheter and providing the guiding image with desirable interactivity. Copyright © 2009 John Wiley & Sons, Ltd. [source] | ||||||||||