Probabilistic guidance for catheter tip motion in cardiac ablation procedures

Radiofrequency catheter ablation is one of the commonly available therapeutic methods for patients suffering from cardiac arrhythmias. The prerequisite of successful ablation is sufficient energy delivery at the target site. However, cardiac and respiratory motion, coupled with endocardial irregularities, can cause catheter drift and dispersion of the radiofrequency energy, thus prolonging procedure time, damaging adjacent tissue, and leading to electrical reconnection of temporarily ablated regions. Therefore, positional accuracy and stability of the catheter tip during energy delivery is of great importance for the outcome of the procedure. This paper presents an analytical scheme for assessing catheter tip stability, whereby a sequence of catheter tip motion recorded at sparse locations on the endocardium is decomposed. The spatial sliding component along the endocardial wall is extracted from the recording and maximal slippage and its associated probability are computed at each mapping point. Finally, a global map is generated, allowing the assessment of potential areas that are compromised by tip slippage. The proposed framework was applied to 40 retrospective studies of congenital heart disease patients and further validated on phantom data and simulations. The results show a good correlation with other intraoperative factors, such as catheter tip contact force amplitude and orientation, and with clinically documented anatomical areas of high catheter tip instability.