title: Visual, tactile, and contact force feedback: which one is more important for catheter ablation? Results from an in vitro experimental study.
abstract: BACKGROUND
  During radiofrequency ablation, effective contact is crucial in determining lesions efficacy.
  
  
  OBJECTIVE
  The purpose of this study was to compare operators' ability to assess contact pressure using visual and tactile feedbacks together or alone in an experimental model.
  
  
  METHODS
  In a in vitro experimental setup replicating manual catheter manipulation and recording the applied force, evaluators were asked to identify three levels of force (first, ablation, and maximum contact) as the catheter contacted the tissue model using (1) visual feedback only by fluoroscopy, "blinded" to touch; (2) tactile feedback only, blinded to fluoroscopy; and (3) both tactile and visual feedback together. The latter was regarded as reference. The experiment was repeated using a catheter force sensing technology during robotic navigation.
  
  
  RESULTS
  During manual navigation, tighter association was shown for the visual method than for the tactile method: median difference with reference: first contact -1 (P = .97) vs -2 (P = .90); ablation contact 2 (P = .1) vs -7 (P = .03); maximum contact 2 (P = .06) vs -28 (P = .02). Bland-Altman plot and Deming regression confirmed for the visual method the good agreement with reference and the absence of bias at any level and showed for the tactile higher values and proportional bias that reached statistical significance at ablation and maximum contact. During robotic navigation, agreement was higher for the tactile than for the visual only method.
  
  
  CONCLUSIONS
  During manual navigation, visual feedback alone is in better agreement with the reference compared to the tactile only approach. During robotic navigation, agreement is looser for the visual only approach. More objective feedback of contact pressure during ablation procedures is desirable.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Department of Heart and Vessels, University of Florence, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Paoletti Perini
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.affiliation: Hansen Medical, Palo Alto, California.
authors.forename: Alex S
authors.initials: AS
authors.lastname: Goldenberg
authors.affiliation: Department of Heart and Vessels, University of Florence, Florence, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Grifoni
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: G
authors.initials: G
authors.lastname: Joseph Gallinghouse
authors.affiliation: Division of Cardiology, University of Catania, Catania, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Conti
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: Hansen Medical, Palo Alto, California.
authors.forename: Aditi
authors.initials: A
authors.lastname: Garg
authors.affiliation: Hansen Medical, Palo Alto, California.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Grogan
authors.affiliation: Hansen Medical, Palo Alto, California.
authors.forename: Dan T
authors.initials: DT
authors.lastname: Wallace
authors.affiliation: Department of Heart and Vessels, University of Florence, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York.
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jais
authors.affiliation: Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France.
authors.forename: Michelle
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiology, Stanford University, California; Case Western Reserve University, Cleveland, Ohio; EP Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California. Electronic address: dr.natale@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005246:Feedback; D005471:Fluoroscopy; D006801:Humans; D066298:In Vitro Techniques; D011312:Pressure; D012371:Robotics; D014110:Touch; D014785:Vision, Ocular
keywords: Ablation; Atrial fibrillation; Complications; Contact force; Fluoroscopy; Impedance