Improved arrhythmia ablation via MR-guided robotic catheterization and multimodal clinician feedback - Project Summary/Abstract: The objective of this proposal is to create a multi-modal feedback-based navigation system and MR- compatible robotic platform that enables precise, continuous, and permanent lesion creation during MR-guided radiofrequency ablation (RFA) for atrial fibrillation (AF) treatment. This research is motivated by the high incidence of AF in US (1 in 100 people), and the suboptimal treatment outcome of traditional approaches (~30- 50% recurrence rate). Recurrence of AF occurs when there are gaps between ablation lesions, which can be caused by multiple reasons, including 1) limited ability to manipulate the catheter in a manner that reaches all desired ablation targets while also 2) maintaining proper catheter-tissue contact force (CTCF) for effective ablation energy delivery. In addition, there is 3) lack of effective navigation methods that accurately identify sites of incomplete ablation and guide the catheter to complete ablation. We recently developed MR-tracked catheterization toolset to perform RFA inside MRI scanner and the MR-based imaging method to assess the lesion outcome intraoperatively. However, manipulating the catheter towards the desired location and maintaining proper contact remains a challenging task. To address these problems, we propose to develop an MR-enabled intraoperative navigation feedback framework and robotic hardware system. From technical perspective, the proposed platform is innovative since current systems do not integrate accurate catheter manipulation and CTCF feedback with MRI-based monitoring and lesion assessment to provide a unified system for AF ablation planning, treatment, and assessment. From the clinical perspective, the proposed platform enables accurate catheter position and contact force control, which supports the creation of continuous and chronic ablation lesions for reducing arrhythmia recurrence. The proposed work will be achieved via three Aims. Aim 1: Navigation feedback. We will further develop navigation software that combines multi-modal sensory feedback (i.e., MR imaging, MR-catheter tracking, CTCF estimation), and visualizes them in an integrated software environment to provide feedback to the physician. Aim 2: MRI robot hardware and control. We will advance our current catheter robot hardware to create a complete system for simultaneous catheter and guiding sheath manipulation. We will develop hybrid position and CTCF control algorithm that enables accurate and stable catheter placement for effective ablation energy delivery. Specific Aim 3: Experimental validations. We will integrate the robot hardware and navigation feedback system, and validate the integrated system first in a beating heart emulating phantom in a 1.5 MRI scanner, and then in 16 MR-guided LA ablation studies on swine.
