Optimal Transseptal Puncture Location for Robot-Assisted Left Atrial Catheter Ablation

Authors:
Jagadeesan Jayender;Rajni V. Patel;Gregory F. Michaud;Nobuhiko Hata
Affiliations:
Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, USA;Department of Electrical and Computer Engineering and Department of Surgery, The University of Western Ontario, Canadian Surgical Technologies and Advanced Robotics (CSTAR), Canada;Department of Cardiology, Harvard Medical School, Brigham and Women's Hospital, USA;Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, USA
Venue:
MICCAI '09 Proceedings of the 12th International Conference on Medical Image Computing and Computer-Assisted Intervention: Part I
Year:
2009

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Abstract

The preferred method of treatment for Atrial Fibrillation (AF) is by catheter ablation wherein 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. 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. Preoperative MR/CT images of the heart are segmented using the open source image-guided therapy software, Slicer 3, 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. Simulation results for the optimization algorithm are presented in this paper.