Percutaneous transluminal catheter (PTC) intervention is a medical technique used to assess and treat vascular and cardiac diseases, including electrophysiological conditions.
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Interventional specialists use the vasculature as a passageway to guide the catheter to the site of interest, using fluoroscopic x-ray imaging for image-guidance. Common PTC procedures include: vascular angiography, inflating balloons and stents, depositing coils, and the treatment of cardiac arrhythmia via catheter ablation.
Catheter ablation has gained prevalence over the last two decades, as the treatment success rate for atrial fibrillation reaches 100%. The close proximity between the interventionalist and the radiation source combined with the increased number of procedures performed annually has lead to increased lifetime exposure; escalating the interventionalist probability of developing cancer, cataracts or passing genetic defects to offspring. Furthermore, the lead garments that protect the interventionalist can lead to musculoskeletal injury. Both these factors have lead to increased occupational risk. Catheter navigation systems are commercially available to reduce these risks. Lack of intuitive design is a common failing among these systems.
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This thesis presents the design and validation of a remote catheter navigation system (RCNS) that utilizes dexterous skills of the interventionalist during remote navigation, by keeping the catheter in their hands of the interventionalist during remote navigation. For remote catheter manipulation, the interventionalist pushes, pulls, and twists an input catheter, which is placed inside an electromechanical sensor (CS). Position changes of the input catheter are transferred to a second electromechanical (CM) that replicates the sensed motion with a second, remote catheter.
Design of this system begins with understanding the dynamic forces applied to the catheter during intravascular navigation. These dynamics were quantified and then used as operating parameters in the mechanical design of the CM. In a laboratory setting, motion sensed and replicated by the RCNS was found to be 1 mm in the axial direction,
1° in the radial direction, with a latency of 180 ms. In a multi-operator, comparative study using a specially constructed multi-path vessel phantom, comparable navigation efficacy was demonstrated between the RCNS and conventional catheter manipulation, with the RCNS requiring only 9s longer to complete the same tasks.
Finally, remote navigation was performed in vivo to fully demonstrate the application of this system towards the diagnosis and treatment of cardiac arrhythmia
