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Optimal Transseptal Puncture Location for Robot Assisted Left Atrial Catheter Ablation

Institution:
1Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2Department of Electrical and Computer Engineering and Department of Surgery, University of Western Ontario, Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, ON, Canada.
3Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4Clinical Image Guidance Laboratory, Center for Integration of Medicine, and Innovative Technology, Massachusetts General Hospital, Boston, MA, USA.
Publisher:
John Wiley & Sons, Inc.
Publication Date:
Jun-2011
Journal:
Int J Med Robot
Volume Number:
7
Issue Number:
2
Pages:
193-201
Citation:
Int J Med Robot. 2011 Jun;7(2):193-201.
PubMed ID:
21538767
Keywords:
Cardiac Ablation, Continuum Robot, optimal port, robot-assisted, global isotropy index
Appears in Collections:
SNR, SLICER, SPL
Sponsors:
Intelligent Surgical Instruments Project, METI Grant, Japan
Generated Citation:
Jayender J., Patel R.V., Michaud G.F., Hata N. Optimal Transseptal Puncture Location for Robot Assisted Left Atrial Catheter Ablation. Int J Med Robot. 2011 Jun;7(2):193-201. PMID: 21538767.
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BACKGROUND: The preferred method of treatment for atrial fibrillation (AF) is by catheter ablation, in which a catheter is guided into the left atrium through a transseptal puncture. However, the transseptal puncture constrains the catheter, thereby limiting its maneuverability and increasing the difficulty in reaching various locations in the left atrium. In this paper, we address the problem of choosing the optimal transseptal puncture location for performing cardiac ablation to obtain maximum maneuverability of the catheter. METHODS: We have employed an optimization algorithm to maximize the global isotropy index (GII) to evaluate the optimal transseptal puncture location. As part of this algorithm, a novel kinematic model for the catheter has been developed, based on a continuum robot model. Pre-operative MR/CT images of the heart are segmented using the open source image-guided therapy software, 3D Slicer, to obtain models of the left atrium and septal wall. These models are input to the optimization algorithm to evaluate the optimal transseptal puncture location. RESULTS: The continuum robot model accurately describes the kinematics of the catheter. Simulation and experimental results for the optimal transseptal puncture location are presented in this paper. The optimization algorithm generates discrete points on the septal wall for which the dexterity of the catheter in the left atrium is maximum, corresponding to a GII of 0.4362. CONCLUSION: We have developed an optimization algorithm based on the GII to evaluate the optimal position of the transseptal puncture for left atrial cardiac ablation.

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