title: Optimal transseptal puncture location for robot-assisted left atrial catheter ablation.
abstract: 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 manoeuvrability 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 manoeuvrability 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.
  
  
  CONCLUSIONS
  We have developed an optimization algorithm based on the GII to evaluate the optimal position of the transseptal puncture for left atrial cardiac ablation.
authors.affiliation: Surgical Planning Laboratory, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. jayender@bwh.harvard.edu
authors.forename: J
authors.initials: J
authors.lastname: Jayender
authors.forename: R V
authors.initials: RV
authors.lastname: Patel
authors.forename: G F
authors.initials: GF
authors.lastname: Michaud
authors.forename: N
authors.initials: N
authors.lastname: Hata
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods*; D002404:Catheterization; D057785:Catheters; D003196:Computer Graphics; D006325:Heart Atria / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D015233:Models, Statistical; D008962:Models, Theoretical; D011677:Punctures; D012371:Robotics