FBG Sensor for Contact Level Monitoring and Prediction of Perforation in Cardiac Ablation

Atrial fibrillation (AF) is the most common type of arrhythmia, and is characterized by a disordered contractile activity of the atria (top chambers of the heart). A popular treatment for AF is radiofrequency (RF) ablation. In about 2.4% of cardiac RF ablation procedures, the catheter is accidently pushed through the heart wall due to the application of excessive force. Despite the various capabilities of currently available technology, there has yet to be any data establishing how cardiac perforation can be reliably predicted. Thus, two new FBG based sensor prototypes were developed to monitor contact levels and predict perforation. Two live sheep were utilized during the study. It was observed during operation that peaks appeared in rhythm with the heart rate whenever firm contact was made between the sensor and the endocardial wall. The magnitude of these peaks varied with pressure applied by the operator. Lastly, transmural perforation of the left atrial wall was characterized by a visible loading phase and a rapid signal drop-off correlating to perforation. A possible pre-perforation signal was observed for the epoxy-based sensor in the form of a slight signal reversal (12–26% of loading phase magnitude) prior to perforation (occurring over 8 s)

Black-box modeling to estimate tissue temperature during radiofrequency catheter cardiac ablation: feasibility study on an agar phantom model

This is an author-created, un-copyedited versíon of an article published in Physiological Measurement. IOP Publishing Ltd is not responsíble for any errors or omissíons in this versíon of the manuscript or any versíon derived from it. The Versíon of Record is available online at http://doi.org/10.1088/0967-3334/31/4/009[EN] The aim of this work was to study linear deterministic models to predict tissue temperature during radiofrequency cardiac ablation (RFCA) by measuring magnitudes such as electrode temperature, power and impedance between active and dispersive electrodes. The concept involves autoregressive models with exogenous input (ARX), which is a particular case of the autoregressive moving average model with exogenous input (ARMAX). The values of the mode parameters were determined from a least-squares fit of experimental data. The data were obtained from radiofrequency ablations conducted on agar models with different contact pressure conditions between electrode and agar (0 and 20 g) and different flow rates around the electrode (1, 1.5 and 2 L min¿1). Half of all the ablations were chosen randomly to be used for identification (i.e. determination of model parameters) and the other half were used for model validation. The results suggest that (1) a linear model can be developed to predict tissue temperature at a depth of 4.5 mm during RF cardiac ablation by using the variables applied power, impedance and electrode temperature; (2) the best model provides a reasonably accurate estimate of tissue temperature with a 60% probability of achieving average errors better than 5 °C; (3) substantial errors (larger than 15 °C) were found only in 6.6% of cases and were associated with abnormal experiments (e.g. those involving the displacement of the ablation electrode) and (4) the impact of measuring impedance on the overall estimate is negligible (around 1 °C).This work was supported by the 'Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica del Ministerio de Educacion y Ciencia' of Spain (TEC200801369/ TEC) and by an R&D contract (CSIC-20060633) between Edwards Lifescience Ltd and the Spanish National Research Council (CSIC). The English revision and correction of this paper was funded by the Universidad Politecnica de Valencia, Spain. We thank L Melecio for his invaluable technical support in conducting the experiments.Blasco-Giménez, R.; Lequerica, JL.; Herrero, M.; Hornero, F.; Berjano, E. (2010). Black-box modeling to estimate tissue temperature during radiofrequency catheter cardiac ablation: feasibility study on an agar phantom model. Physiological Measurement. 31(4):581-594. https://doi.org/10.1088/0967-3334/31/4/009S581594314Hong Cao, Tungjitkusolmun, S., Young Bin Choy, Jang-Zern Tsai, Vorperian, V. R., & Webster, J. G. (2002). Using electrical impedance to predict catheter-endocardial contact during RF cardiac ablation. IEEE Transactions on Biomedical Engineering, 49(3), 247-253. doi:10.1109/10.983459Hong Cao, Vorperian, V. R., Jang-Zem Tsai, Tungjitkusolmun, S., Eung Je Woo, & Webster, J. G. (2000). Temperature measurement within myocardium during in vitro RF catheter ablation. IEEE Transactions on Biomedical Engineering, 47(11), 1518-1524. doi:10.1109/10.880104Hamner, C. E., Potter, D. D., Cho, K. R., Lutterman, A., Francischelli, D., Sundt, T. M., & Schaff, H. V. (2005). Irrigated Radiofrequency Ablation With Transmurality Feedback Reliably Produces Cox Maze Lesions In Vivo. The Annals of Thoracic Surgery, 80(6), 2263-2270. doi:10.1016/j.athoracsur.2005.06.017HARTUNG, W. M., BURTON, M. E., DEAM, A. G., WALTER, P. F., McTEAGUE, K., & LANGBERG, J. J. (1995). Estimation of Temperature During Radiofrequency Catheter Ablation Using Impedance Measurements. Pacing and Clinical Electrophysiology, 18(11), 2017-2021. doi:10.1111/j.1540-8159.1995.tb03862.xDing Sheng He, Bosnos, M., Mays, M. Z., & Marcus, F. (2003). Assessment of myocardial lesion size during in vitro radio frequency catheter ablation. IEEE Transactions on Biomedical Engineering, 50(6), 768-776. doi:10.1109/tbme.2003.812161KO, W.-C., HUANG, S. K. S., LIN, J.-L., SHAU, W.-Y., LAI, L.-P., & CHEN, P. H. (2001). New Method for Predicting Efficiency of Heating by Measuring Bioimpedance During Radiofrequency Catheter Ablation in Humans. Journal of Cardiovascular Electrophysiology, 12(7), 819-823. doi:10.1046/j.1540-8167.2001.00819.xLabonte, S. (1994). Numerical model for radio-frequency ablation of the endocardium and its experimental validation. IEEE Transactions on Biomedical Engineering, 41(2), 108-115. doi:10.1109/10.284921Lai, Y.-C., Choy, Y. B., Haemmerich, D., Vorperian, V. R., & Webster, J. G. (2004). Lesion Size Estimator of Cardiac Radiofrequency Ablation at Different Common Locations With Different Tip Temperatures. IEEE Transactions on Biomedical Engineering, 51(10), 1859-1864. doi:10.1109/tbme.2004.831529Lequerica, J. L., Berjano, E. J., Herrero, M., Melecio, L., & Hornero, F. (2008). A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom. Physics in Medicine and Biology, 53(4), N25-N34. doi:10.1088/0031-9155/53/4/n01Mattingly, M., Bailey, E. A., Dutton, A. W., Roemer, R. B., & Devasia, S. (1998). Reduced-order modeling for hyperthermia: an extended balanced-realization-based approach. IEEE Transactions on Biomedical Engineering, 45(9), 1154-1162. doi:10.1109/10.709559PILCHER, T. A., SANFORD, A. L., SAUL, J. P., & HAEMMERICH, D. (2006). Convective Cooling Effect on Cooled-Tip Catheter Compared to Large-Tip Catheter Radiofrequency Ablation. Pacing and Clinical Electrophysiology, 29(12), 1368-1374. doi:10.1111/j.1540-8159.2006.00549.xRodríguez, I., Lequerica, J. L., Berjano, E. J., Herrero, M., & Hornero, F. (2007). Esophageal temperature monitoring during radiofrequency catheter ablation: experimental study based on an agar phantom model. Physiological Measurement, 28(5), 453-463. doi:10.1088/0967-3334/28/5/001SCHUMACHER, B., EICK, O., WITTKAMPF, F., PEZOLD, C., TEBBENJOHANNS, J., JUNG, W., & LUDERITZ, B. (1999). Temperature Response Following Nontraumatic Low Power Radiofrequency Application. Pacing and Clinical Electrophysiology, 22(2), 339-343. doi:10.1111/j.1540-8159.1999.tb00448.xTeixeira, C. A., Ruano, A. E., Ruano, M. G., Pereira, W. C. A., & Negreira, C. (2006). Non-invasive temperature prediction of in vitro therapeutic ultrasound signals using neural networks. Medical & Biological Engineering & Computing, 44(1-2), 111-116. doi:10.1007/s11517-005-0004-2Teixeira, C. A., Ruano, M. G., Ruano, A. E., & Pereira, W. C. A. (2008). A Soft-Computing Methodology for Noninvasive Time-Spatial Temperature Estimation. IEEE Transactions on Biomedical Engineering, 55(2), 572-580. doi:10.1109/tbme.2007.90102

Lumped Element Electrical Model based on Three Resistors for Electrical Impedance in Radiofrequency Cardiac Ablation: Estimations from Analytical Calculations and Clinical Data

[EN] The electrical impedance measured during radiofrequency cardiac ablation (RFCA) is widely used in clinical studies to predict the heating evolution and hence the success of the procedure. We hypothesized that a model based on three resistors in series can mimic the total electrical impedance measured during RFCA. The three resistors or impedances are given by: impedance associated with the tissue around the active electrode (myocardium and circulating blood) (Z-A), that associated with the tissue around the dispersive electrode (Z-DE) and that associated with the rest of the body (Z-B). Our objective was to quantify the values associated with these three impedance types by an analytical method, after which the values obtained would be compared to those estimated from clinical data from previous studies. The results suggest that an RFCA using a 7 Fr 4-mm electrode would give a Z-A of around 75 ohms, a Z-DE around 20 ohms, and Z-B would be 15±10 ohms (for body surface area variations between 1.5 and 2.5 m^2). Finally, adaptations of the proposed model were used to explain the results of previous clinical studies using a different electrode arrangement, such as in bipolar ablation of the ventricular septum.This work received financial support from the Spanish “Plan Nacional de I+D+I del Ministerio de Ciencia e Innovación” Grant No. TEC2011-27133-C02-01.Berjano, E.; D Avila, A. (2013). Lumped Element Electrical Model based on Three Resistors for Electrical Impedance in Radiofrequency Cardiac Ablation: Estimations from Analytical Calculations and Clinical Data. The Open Biomedical Engineering Journal. 7:62-70. https://doi.org/10.2174/1874120720130603001S62707Nath S, Haines D E. “Biophysics and pathology of catheter energy delivery systems” Prog Cardiovasc Dis 1995 January-February; 37 : 185-204.Berjano E J. “Theoretical modeling for radiofrequency ablation: state-of-the-art and challenges for the future” Biomed Eng Online 2006 April; 5 : 2.Wittkampf F H, and Nakagawa H. “RF catheter ablation: Lessons on lesions” Pacing Clin Electrophysiol 2006 November; 29 : 1285-97.Neufeld G R GR. “Principles and hazards of electrosurgery including laparoscopy” Surg Gynecol Obstet 1978 November; 147 : 705-10.Ragheb T, Riegle S, Geddes L A, and Amin V. “The impedance of a spherical monopolar electrode” Ann Biomed Eng 1992; 20 : 617-27.Panescu D, Whayne J G, Fleischman S D, Mirotznik M S, Swanson D K, and Webster J G. “Three-dimensional finite element analysis of current density and temperature distributions during radio- frequency ablation” IEEE Trans Biomed Eng 1995 September; 42 : 879-90.Foster K R, Schwan H P. “Dielectric properties of tissues and biological materials: a critical review” Crit Rev Biomed Eng 1989; 17 : 25-104.Pearce J A. Electrosurgery. London: Chapman and Hall 1986.Yamamoto T, and Yamamoto Y. “Electrical properties of the epidermal stratum corneum” Med Biol Eng 1976 March; 14 : 151-8.Miklavcic D, Pavselj N, Hart F X. “Electric Properties of Tissues” In: Akay M, Ed. Wiley Encyclopedia of Biomedical Engineering. Hoboken: Wiley 2006; pp. 1-14.Saito M, Nakayama K, Hori M, Fujimori Y. “A fundamental study on the electrodes for cardiac pacemakers” Jpn J Med Electron Biol Eng 1967; 5 : 192-8.Nsah E, Berger R, Rosenthal L, et al. “Relation between impedance and electrode temperature during radiofrequency catheter ablation of accessory pathways and atrioventricular nodal reentrant tachycardia” Am Heart J 1998 November; 136 : 844-51.Wen Z C, Chen S A, Chiang C E, et al. “Temperature and impedance monitoring during radiofrequency catheter ablation of slow AV node pathway in patients with atrioventricular node reentrant tachycardia” Int J Cardiol 1996 December; 57 : 257-63.Strickberger S A, Hummel J, Gallagher M, et al. “Effect of accessory pathway location on the efficiency of heating during radiofrequency catheter ablation” Am Heart J 1995 January; 129 : 54-8.Strickberger S A, Vorperian V R, Man K C, et al. “Relation between impedance and endocardial contact during radiofrequency catheter ablation” Am Heart J 1994 August; 128 : 226-9.Cao H, Tungjitkusolmun S, Choy Y B, Tsai J Z, Vorperian V R, and Webster J G. “Using electrical impedance to predict catheter-endocardial contact during RF cardiac ablation” IEEE Trans Biomed Eng 2002 March; 49 : 247-3.Rodriguez L M, Nabar A, Timmermans C, and Wellens H J. “Comparison of results of an 8-mm split-tip versus a 4-mm tip ablation catheter to perform radiofrequency ablation of type I atrial flutter” Am J Cardiol 2000 January; 85 : 109-12.Sacher F F, O'Neill M D, Jais P, et al. “Prospective randomized comparison of 8-mm gold-tip, externally irrigated-tip and 8-mm platinum- iridium tip catheters for cavotricuspid isthmus ablation” J Cardiovasc Electrophysiol 2007 July; 18 : 709-13.Jackman W M, Wang X Z, Friday K J, et al. “Catheter ablation of atrioventricular junction using radiofrequency current in 17 patients. Comparison of standard and large-tip catheter electrodes” Circulation 1991 May; 83 : 1562-76.Nath S, DiMarco J P, Gallop R G, McRury I D, and Haines D E. “Effects of dispersive electrode position and surface area on electrical parameters and temperature during radiofrequency catheter ablation” Am J Cardiol 1996 April; 77 : 765-7.Santoro I, Xunzhang W, McClelland J, et al. “Effect of skin-patch location and surface area on impedance during radiofrequency catheter ablation” Pacing Clin Electrophysiol 1992; 15 : 580.Borganelli M, el-Atassi R, Leon A, et al. “Determinants of impedance during radiofrequency catheter ablation in humans” Am J Cardiol 1992 April; 69 : 1095-7.Park J K, Halperin B D, Kron J, Holcomb S R, and Silka M J. “Analysis of body surface area as a determinant of impedance during radiofrequency catheter ablation in adults and children” J Electrocardiol 1994 October; 27 : 329-32.Wang D, Hulse J E, Walsh E P, and Saul J P. “Factors influencing impedance during radiofrequency ablation in humans” Chin Med J (Engl) 1995 June; 108 : 450-5.Koruth J S, Dukkipati S, Miller M A, Neuzil P, d'Avila A, and Reddy V Y. “Bipolar irrigated radiofrequency ablation: a therapeutic option for refractory intramural atrial and ventricular tachycardia circuits” Heart Rhythm 2012 December; 9 : 1932-41

Evaluating Electrode-Tissue Contact Force Using the Moving Pattern of the Catheter Tip and the Electrogram Characteristics

As an important reference for the physician during catheter ablation, the electrode-tissue contact force (CF), is one of the key points for the success of the catheter ablation. With the guide of CF sensing, the ablation procedure can be safer and more effective. Techniques and apparatus have been refined since catheter ablation was invented to treat cardiac arrhythmia. In the review part, different techniques for evaluating the electrode-tissue CF are discussed, including both direct and indirect measurement. Sensor-based direct measurement is broadly applied but restricted by the high cost. Surrogate markers of catheter-tissue contact such as impedance, electrogram (EGM) quality, catheter tip temperature and so on, are taken as reference evaluating CF as well, but each of them has their own drawbacks. In this dissertation, our approach estimating the CF is based on the moving pattern of the catheter tip in the heart chamber. The factors determining the catheter tip motion, include the cardiac and respiratory cycles, blood flow, and so on. If the position of the catheter tip can be recorded, then the motion of the catheter tip can be tracked and analyzed. Based on our collected data, the moving pattern of the catheter tip is different when the electrode-tissue CF level varies. Features extracted from catheter tip motion are significant for CF evaluation. There are different features selected to describe the moving pattern of the catheter tip, which are identified to best represent the movement by checking the corresponding CF as reference. In summary, if the feature has a strong correlation with the CF, then it can be taken as a good feature. Using the features as input, the CF evaluating mechanism is based on a multi-class classification decision tree to make an optimum and comprehensive estimation

Design and development of optical reflectance spectroscopy and optical coherence tomography catheters for myocardial tissue characterization

Catheter ablation therapy attempts to restore sinus rhythm in arrhythmia patients by producing site-specific tissue modification along regions which cause abnormal electrical activity. This treatment, though widely used, often requires repeat procedures to observe long-term therapeutic benefits. This limitation is driven in part by challenges faced by conventional schemes in validating lesion adequacy at the time of the procedure. Optical techniques are well-suited for the interrogation and characterization of biological tissues. In particular, optical coherence tomography (OCT) relies on coherence gating of singly-scattered light to enable high-resolution structural imaging for tissue diagnostics and procedural guidance. Alternatively, optical reflectance spectroscopy (ORS) is a point measurement technique which makes use of incoherent, multiply-scattered light to probe tissue volumes and derive important data from its optical signature. ORS relies on the fact that light-tissue interactions are regulated by absorption and scattering, which directly relate to the intrinsic tissue biochemistry and cellular organization. In this thesis, we explore the integration of these modalities into ablation catheters for obtaining procedural metrics which could be utilized to guide catheter ablation therapy. We first present the development of an accelerated computational light transport model and its application for guiding ORS catheter design. A custom ORS-integrated ablation catheter is then implemented and tested within porcine specimens in vitro. A model is proposed for real-time estimation of lesion size based on changes in spectral morphology acquired during ablation. We then fabricated custom integrated OCT M-mode RF catheters and present a model for detecting contact status based on deep convolutional neural networks trained on endomyocardial images. Additionally, we demonstrate for the first time, tracking of RF-induced lesion formation employing OCT Doppler micro-velocimetry; this response is shown to be commensurate with the degree of treatment. We further demonstrate for the first time spectroscopic tracking of kinetics related to the heme oxidation cascade during thermal treatment, which are linked to tissue denaturation. The pairing of these modalities into a single RF catheter was also validated for guiding lesion delivery in vitro and within live pigs. Finally, we conclude with a proof-of-concept demonstration of ORS as a mapping tool to guide epicardial ablation in human donor hearts. These results showcase the vast potential of ORS and OCT empowered RF catheters for aiding intraprocedural guidance of catheter ablation procedures which could be utilized alongside current practices

Could it be advantageous to tune the temperature controller during radiofrequency ablation? A feasibility study using theoretical models

Purpose: To assess whether tailoring the Kp and Ki values of a proportional-integral (PI) controller during radiofrequency (RF) cardiac ablation could be advantageous from the point of view of the dynamic behaviour of the controller, in particular, whether control action could be speeded up and larger lesions obtained. Methods: Theoretical models were built and solved by the finite element method. RF cardiac ablations were simulated with temperature controlled at 55 degrees C. Specific PI controllers were implemented with Kp and Ki parameters adapted to cases with different tissue values (specific heat, thermal conductivity and electrical conductivity) electrode-tissue contact characteristics (insertion depth, cooling effect of circulating blood) and electrode characteristics (size, location and arrangement of the temperature sensor in the electrode). Results: The lesion dimensions and T(max) remained almost unchanged when the specific PI controller was used instead of one tuned for the standard case: T(max) varied less than 1.9 degrees C, lesion width less than 0.2 mm, and lesion depth less than 0.3 mm. As expected, we did observe a direct logical relationship between the response time of each controller and the transient value of electrode temperature. Conclusion: The results suggest that a PI controller designed for a standard case (such as that described in this study), could offer benefits under different tissue conditions, electrode-tissue contact, and electrode characteristics.This work received financial support from the Spanish 'Plan Nacional de I+D+I del Ministerio de Ciencia e Innovacion' Grant no. TEC2008-01369/TEC and FEDER Project MTM2010-14909. The translation of this paper was funded by the Universitat Politecnica de Valencia, Spain. The authors alone are responsible for the content and writing of the paperAlba Martínez, J.; Trujillo Guillen, M.; Blasco Giménez, RM.; Berjano Zanón, E. (2011). Could it be advantageous to tune the temperature controller during radiofrequency ablation? A feasibility study using theoretical models. International Journal of Hyperthermia. 27(6):539-548. https://doi.org/10.3109/02656736.2011.586665S539548276Gaita, F., Caponi, D., Pianelli, M., Scaglione, M., Toso, E., Cesarani, F., … Leclercq, J. F. (2010). Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism? Circulation, 122(17), 1667-1673. doi:10.1161/circulationaha.110.937953Anfinsen, O.-G., Aass, H., Kongsgaard, E., Foerster, A., Scott, H., & Amlie, J. P. (1999). Journal of Interventional Cardiac Electrophysiology, 3(4), 343-351. doi:10.1023/a:1009840004782PETERSEN, H. H., CHEN, X., PIETERSEN, A., SVENDSEN, J. H., & HAUNSO, S. (2000). Tissue Temperatures and Lesion Size During Irrigated Tip Catheter Radiofrequency Ablation: An In Vitro Comparison of Temperature-Controlled Irrigated Tip Ablation, Power-Controlled Irrigated Tip Ablation, and Standard Temperature-Controlled Ablation. Pacing and Clinical Electrophysiology, 23(1), 8-17. doi:10.1111/j.1540-8159.2000.tb00644.xTungjitkusolmun, S., Woo, E. J., Cao, H., Tsai, J. Z., Vorperian, V. R., & Webster, J. G. (2000). Thermal—electrical finite element modelling for radio frequency cardiac ablation: Effects of changes in myocardial properties. Medical & Biological Engineering & Computing, 38(5), 562-568. doi:10.1007/bf02345754Lai, Y.-C., Choy, Y. B., Haemmerich, D., Vorperian, V. R., & Webster, J. G. (2004). Lesion Size Estimator of Cardiac Radiofrequency Ablation at Different Common Locations With Different Tip Temperatures. IEEE Transactions on Biomedical Engineering, 51(10), 1859-1864. doi:10.1109/tbme.2004.831529Jain, M. K., & Wolf, P. D. (1999). Temperature-controlled and constant-power radio-frequency ablation: what affects lesion growth? IEEE Transactions on Biomedical Engineering, 46(12), 1405-1412. doi:10.1109/10.804568Panescu, D., Whayne, J. G., Fleischman, S. D., Mirotznik, M. S., Swanson, D. K., & Webster, J. G. (1995). Three-dimensional finite element analysis of current density and temperature distributions during radio-frequency ablation. IEEE Transactions on Biomedical Engineering, 42(9), 879-890. doi:10.1109/10.412649Hong Cao, Vorperian, V. R., Tungjitkusolmun, S., Jan-Zern Tsai, Haemmerich, D., Young Bin Choy, & Webster, J. G. (2001). Flow effect on lesion formation in RF cardiac catheter ablation. IEEE Transactions on Biomedical Engineering, 48(4), 425-433. doi:10.1109/10.915708Tungjitkusolmun, S., Vorperian, V. R., Bhavaraju, N., Cao, H., Tsai, J.-Z., & Webster, J. G. (2001). Guidelines for predicting lesion size at common endocardial locations during radio-frequency ablation. IEEE Transactions on Biomedical Engineering, 48(2), 194-201. doi:10.1109/10.909640Schutt, D., Berjano, E. J., & Haemmerich, D. (2009). Effect of electrode thermal conductivity in cardiac radiofrequency catheter ablation: A computational modeling study. International Journal of Hyperthermia, 25(2), 99-107. doi:10.1080/02656730802563051Langberg, J. J., Calkins, H., el-Atassi, R., Borganelli, M., Leon, A., Kalbfleisch, S. J., & Morady, F. (1992). Temperature monitoring during radiofrequency catheter ablation of accessory pathways. Circulation, 86(5), 1469-1474. doi:10.1161/01.cir.86.5.1469Calkins, H., Prystowsky, E., Carlson, M., Klein, L. S., Saul, J. P., & Gillette, P. (1994). Temperature monitoring during radiofrequency catheter ablation procedures using closed loop control. Atakr Multicenter Investigators Group. Circulation, 90(3), 1279-1286. doi:10.1161/01.cir.90.3.1279Lennox CD, Temperature controlled RF coagulation. Patent number: 5.122.137 Hudson NHEdwards SD, Stern RA, Electrode and associated system using thermally insulated temperature sensing elements. Patent number: US Patent 5,456,682Panescu D, Fleischman SD, Whayne JG, Swanson DK, (EP Technology. Effects of temperature sensor placement on performance of temperature-controlled ablation. IEEE 17th Annual Conference, Engineering in Medicine and Biology Society, Montreal, Canada (1995)BLOUIN, L. T., MARCUS, F. I., & LAMPE, L. (1991). Assessment of Effects of a Radiofrequency Energy Field and Thermistor Location in an Electrode Catheter on the Accuracy of Temperature Measurement. Pacing and Clinical Electrophysiology, 14(5), 807-813. doi:10.1111/j.1540-8159.1991.tb04111.xBerjano, E. J. (2006). BioMedical Engineering OnLine, 5(1), 24. doi:10.1186/1475-925x-5-24Bhavaraju, N. C., Cao, H., Yuan, D. Y., Valvano, J. W., & Webster, J. G. (2001). Measurement of directional thermal properties of biomaterials. IEEE Transactions on Biomedical Engineering, 48(2), 261-267. doi:10.1109/10.909647Hong Cao, Tungjitkusolmun, S., Young Bin Choy, Jang-Zern Tsai, Vorperian, V. R., & Webster, J. G. (2002). Using electrical impedance to predict catheter-endocardial contact during RF cardiac ablation. IEEE Transactions on Biomedical Engineering, 49(3), 247-253. doi:10.1109/10.983459PETERSEN, H. H., & SVENDSEN, J. H. (2003). Can Lesion Size During Radiofrequency Ablation Be Predicted By the Temperature Rise to a Low Power Test Pulse in Vitro? Pacing and Clinical Electrophysiology, 26(8), 1653-1659. doi:10.1046/j.1460-9592.2003.t01-1-00248.xLANGBERG, J. J., LEE, M. A., CHIN, M. C., & ROSENQVIST, M. (1990). Radiofrequency Catheter Ablation: The Effect of Electrode Size on Lesion Volume In Vivo. Pacing and Clinical Electrophysiology, 13(10), 1242-1248. doi:10.1111/j.1540-8159.1990.tb02022.