Probabilistic guidance for catheter tip motion in cardiac ablation procedures

Abstract

Radiofrequency catheter ablation is one of the commonly available therapeutic methods for patients suffering from cardiac arrhythmias. The prerequisite of successful ablation is sufficient energy delivery at the target site. However, cardiac and respiratory motion, coupled with endocardial irregularities, can cause catheter drift and dispersion of the radiofrequency energy, thus prolonging procedure time, damaging adjacent tissue, and leading to electrical reconnection of temporarily ablated regions. Therefore, positional accuracy and stability of the catheter tip during energy delivery is of great importance for the outcome of the procedure. This paper presents an analytical scheme for assessing catheter tip stability, whereby a sequence of catheter tip motion recorded at sparse locations on the endocardium is decomposed. The spatial sliding component along the endocardial wall is extracted from the recording and maximal slippage and its associated probability are computed at each mapping point. Finally, a global map is generated, allowing the assessment of potential areas that are compromised by tip slippage. The proposed framework was applied to 40 retrospective studies of congenital heart disease patients and further validated on phantom data and simulations. The results show a good correlation with other intraoperative factors, such as catheter tip contact force amplitude and orientation, and with clinically documented anatomical areas of high catheter tip instability.

Cryoablation to improve catheter stability and ablation success in the right atrioventricular groove

“…Our experience suggests a potential role for cryoablation of arrhythmia substrates on the right AV groove where RF ablation fails primarily due to catheter instability. RF catheter ablation is a proven therapy for various cardiac arrhythmias but it relies on adequate energy delivery to the target tissue, and therefore catheter tip stability at this desired location is key for ablation success [ 2 ]. Catheter instability is particularly problematic at the right AV groove [ 3 ] and around the left ventricular papillary muscles [ 6 ].…”

“…To facilitate successful substrate ablation in areas with catheter tip instability, various techniques have been described. Electroanatomic mapping systems localize the ablation catheter tip in real-time using an electromagnetic field and extrapolate spatial data to construct maps [ 2 ]. Paired with electrogram voltage, this aids to guide the catheter [ 2 ].…”

“…Electroanatomic mapping systems localize the ablation catheter tip in real-time using an electromagnetic field and extrapolate spatial data to construct maps [ 2 ]. Paired with electrogram voltage, this aids to guide the catheter [ 2 ]. Contact force sensing catheters measure the “force” of catheter contact, which indirectly measures catheter stability and approximates lesion quality [ 2 ].…”

“…Radiofrequency (RF) ablation is a standard therapy for the management of various arrhythmias [ 1 ]. Successful RF ablation relies on accurate and stable catheter tip contact with the target tissue for curative energy delivery, and catheter instability commonly limits the success of such procedures [ 1 , 2 ]. Catheter instability is particularly problematic in procedures involving arrhythmias originating from or caused by substrates at the right atrioventricular (AV) groove [ 3 ], illustrated by the lower ablation success rate of right-sided accessory pathways compared to left [ 4 , 5 ] and the higher incidence of recurrent accessory pathway conduction on the right compared to left [ 4 , 5 ].…”

“…Catheter instability is particularly problematic in procedures involving arrhythmias originating from or caused by substrates at the right atrioventricular (AV) groove [ 3 ], illustrated by the lower ablation success rate of right-sided accessory pathways compared to left [ 4 , 5 ] and the higher incidence of recurrent accessory pathway conduction on the right compared to left [ 4 , 5 ]. Techniques which optimize catheter stability include the use of pre-formed and deflectable sheaths, contact force sensing and/or cooled-tip ablation catheters which increase the lesion power to compensate for instability [ 2 , 6 ]. Cryo-ablation is an alternative to catheter ablation [ 7 ].…”