Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrodetissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well.
In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel[1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.
In this work, we propose a phantom experiment method to quantitatively evaluate an intraoperative left-atrial modeling update method. In prior work, we proposed an update procedure which updates the preoperative surface model with information from real-time tracked 2D ultrasound. Prior studies did not evaluate the reconstruction using an anthropomorphic phantom. In this approach, a silicone heart phantom (based on a high resolution human atrial surface model reconstructed from CT images) was made as simulated atriums. A surface model of the left atrium of the phantom was deformed by a morphological operation – simulating the shape difference caused by organ deformation between pre-operative scanning and intra-operative guidance. During the simulated procedure, a tracked ultrasound catheter was inserted into right atrial phantom – scanning the left atrial phantom in a manner mimicking the cardiac ablation procedure. By merging the preoperative model and the intraoperative ultrasound images, an intraoperative left atrial model was reconstructed. According to results, the reconstruction error of the modeling method is smaller than the initial geometric difference caused by organ deformation. As the area of the left atrial phantom scanned by ultrasound increases, the reconstruction error of the intraoperative surface model decreases. The study validated the efficacy of the modeling method.
KEYWORDS: Data modeling, 3D modeling, Ultrasonography, Clouds, Error analysis, Reconstruction algorithms, Computed tomography, Process modeling, Computer simulations, 3D image processing
In this work, we propose a method for intraoperative reconstruction of a left atrial surface model for the application of cardiac ablation therapy. In this approach, the intraoperative point cloud is acquired by a tracked, 2D freehand intra-cardiac echocardiography device, which is registered and merged with a preoperative, high resolution left atrial surface model built from computed tomography data. For the surface reconstruction, we introduce a novel method to estimate the normal vector of the point cloud from the preoperative left atrial model, which is required for the Poisson Equation Reconstruction algorithm. In the current work, the algorithm is evaluated using a preoperative surface model from patient computed tomography data and simulated intraoperative ultrasound data. Factors such as intraoperative deformation of the left atrium, proportion of the left atrial surface sampled by the ultrasound, sampling resolution, sampling noise, and registration error were considered through a series of simulation experiments.
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