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Heart Rhythm. 2014 Mar;11(3):506-13. doi: 10.1016/j.hrthm.2013.11.016. Epub 2013 Nov 16.

Visual, tactile, and contact force feedback: which one is more important for catheter ablation? Results from an in vitro experimental study.

Author information

  • 1Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
  • 2Department of Heart and Vessels, University of Florence, Florence, Italy.
  • 3Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
  • 4Hansen Medical, Palo Alto, California.
  • 5Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
  • 6Division of Cardiology, University of Catania, Catania, Italy.
  • 7Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York.
  • 8Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France.
  • 9Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiology, Stanford University, California; Case Western Reserve University, Cleveland, Ohio; EP Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California. Electronic address: dr.natale@gmail.com.

Abstract

BACKGROUND:

During radiofrequency ablation, effective contact is crucial in determining lesions efficacy.

OBJECTIVE:

The purpose of this study was to compare operators' ability to assess contact pressure using visual and tactile feedbacks together or alone in an experimental model.

METHODS:

In a in vitro experimental setup replicating manual catheter manipulation and recording the applied force, evaluators were asked to identify three levels of force (first, ablation, and maximum contact) as the catheter contacted the tissue model using (1) visual feedback only by fluoroscopy, "blinded" to touch; (2) tactile feedback only, blinded to fluoroscopy; and (3) both tactile and visual feedback together. The latter was regarded as reference. The experiment was repeated using a catheter force sensing technology during robotic navigation.

RESULTS:

During manual navigation, tighter association was shown for the visual method than for the tactile method: median difference with reference: first contact -1 (P = .97) vs -2 (P = .90); ablation contact 2 (P = .1) vs -7 (P = .03); maximum contact 2 (P = .06) vs -28 (P = .02). Bland-Altman plot and Deming regression confirmed for the visual method the good agreement with reference and the absence of bias at any level and showed for the tactile higher values and proportional bias that reached statistical significance at ablation and maximum contact. During robotic navigation, agreement was higher for the tactile than for the visual only method.

CONCLUSION:

During manual navigation, visual feedback alone is in better agreement with the reference compared to the tactile only approach. During robotic navigation, agreement is looser for the visual only approach. More objective feedback of contact pressure during ablation procedures is desirable.

© 2014 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

KEYWORDS:

Ablation; Atrial fibrillation; Complications; Contact force; Fluoroscopy; Impedance

PMID:
24252284
[PubMed - in process]
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