Low Contact Force Research Articles

High Incidence of Low Catheter-Tissue Contact Force at the Cavotricuspid Isthmus During Catheter Ablation of Atrial Flutter: Implications for Achieving Isthmus Block.

Recurrent atrial flutter following cavotricuspid isthmus (CTI) ablation remains a significant problem. The prevalence of low contact force (CF) during CTI ablation using standard tools is unknown. Our aim was to characterize the prevalence of low CF applications when experienced operators performed CTI ablation using "traditional" markers of contact blinded to CF measurements. Average CF (grams, g) and force-time integral (FTI) was analyzed in 458 lesions in 17 patients undergoing CTI ablation. The isthmus was divided into the annular, mid and caval segments for region-specific analysis. Despite "good" contact using traditional markers, there was significant variability in CF within each isthmus segment (e.g., annular CTI 1-57 g). A high proportion of lesions had a CF <10 g (40%). Lowest CF was the annular (median 9 g), followed by the mid (12 g) and the caval CTI (18 g, P < 0.001). Sites of acute CTI re-connection had a lower average CF and FTI than nonreconnected sites (P < 0.05). Each 1 g increase in CF was associated with a 16% reduction in risk of recovered CTI conduction (95% confidence interval: 4-27%, P = 0.01). Use of surrogate markers of "good contact" during ablation by experienced operators in the absence of real-time CF sensing resulted in nearly half of all lesions being delivered with low CF with marked region-specific variability in CF. Low CF was implicated in longer time to achieve conduction block and increased risk of acute reconnection. These findings underscore the importance of real-time CF measurements for optimizing ablation of typical atrial flutter.

In vivo contact force measurements and correlation with left atrial anatomy during catheter ablation of atrial fibrillation.

Lesion formation during catheter ablation crucially depends on catheter-tissue contact. We sought to evaluate the impact of anatomical characteristics of the left atrium (LA) and the pulmonary veins (PVs) on contact force (CF) measurements. An anatomical map of the LA was obtained in 25 patients prior to catheter ablation of atrial fibrillation. Contact force (operator blinded) and local bipolar electrogram amplitudes (EGM) were measured in eight pre-defined segments around the PVs. After unblinding, points with low CF (≤5 g) were corrected to CF >5 g, and the distance between points was measured. In a pre-procedural computed tomography of the heart, LA volume as well as sizes and circumferences of the PV ostia were measured and correlated to CF measurements. Four hundred and twenty-six points in eight pre-defined LA locations were assessed. Low CF (<5 g) was found in 25.0% (43.5%) of points superior, 33.3% (66.7%) anterior, 32.1% (44.4%) inferior, and 15.5% (15.9%) posterior to the right (left) PVs. The mean distance after correction was 5.8 ± 3.4 mm. Local bipolar electrogram amplitudes between low- and high-CF points did not differ (1.21 ± 1.54 vs. 1.13 ± 1.3 mV, P = ns). The mean CF at the left PVs was significantly lower than at the right PVs (7.91 ± 3.74 vs. 13.95 ± 6.34 g, P < 0.001), with the lowest CF anterior to the left PVs (5.2 ± 3.6 g). Contact force measurements did not correlate to LA volume, size, and circumference of the PVs. Contact force during LA mapping significantly differs according to the location within the LA. These differences are independent of LA volume and anatomy of the PV ostia.

Relationship between catheter contact force and radiofrequency lesion size and incidence of steam pop in the beating canine heart: electrogram amplitude, impedance, and electrode temperature are poor predictors of electrode-tissue contact force and lesion size.

Electrode-tissue contact force (CF) is believed to be a major factor in radiofrequency lesion size. The purpose of this study was to determine, in the beating canine heart, the relationship between CF and radiofrequency lesion size and the accuracy of predicting CF and lesion size by measuring electrogram amplitude, impedance, and electrode temperature. Eight dogs were studied closed chest. Using a 7F catheter with a 3.5 mm irrigated electrode and CF sensor (TactiCath, St. Jude Medical), radiofrequency applications were delivered to 3 separate sites in the right ventricle (30 W, 60 seconds, 17 mL/min irrigation) and 3 sites in the left ventricle (40 W, 60 seconds, 30 mL/min irrigation) at (1) low CF (median 8 g); (2) moderate CF (median 21 g); and (3) high CF (median 60 g). Dogs were euthanized and lesion size was measured. At constant radiofrequency and time, lesion size increased significantly with increasing CF (P<0.01). The incidence of a steam pop increased with both increasing CF and higher power. Peak electrode temperature correlated poorly with lesion size. The decrease in impedance during the radiofrequency application correlated well with lesion size for lesions in the left ventricle but less well for lesions in the right ventricle. There was a poor relationship between CF and the amplitude of the bipolar or unipolar ventricular electrogram, unipolar injury current, and impedance. Radiofrequencylesion size and the incidence of steam pop increase strikingly with increasing CF. Electrogram parameters and initial impedance are poor predictors of CF for radiofrequency ablation.

Liquid contact resonance AFM: analytical models, experiments, and limitations

Contact resonance AFM (CR-AFM) is a scanning probe microscopy technique that utilizes the contact resonances of the AFM cantilever for concurrent imaging of topography and surface stiffness. The technique has not been used in liquid until recently due to analytical and experimental difficulties, associated with viscous damping of cantilever vibrations and fluid loading effects. To address these difficulties, (i) an analytical approach for contact resonances in liquid is developed, and (ii) direct excitation of the contact resonances is demonstrated by actuating the cantilever directly in a magnetic field. By implementing the analytical approach and the direct actuation through magnetic particles, quantitative stiffness imaging on surfaces with a wide range of stiffness can be achieved in liquid with soft cantilevers and low contact forces.

Relations between contact force, bipolar voltage amplitude, and mapping point distance from the left atrial surfaces of 3D ultrasound– and merged 3D CT–derived images: Implication for atrial fibrillation mapping and ablation

Catheter tip-derived contact force (CF) and 3-dimensional (3D) maps are key to mapping and ablation of atrial fibrillation. This study sought to determine the relation between CF and 3D map surfaces. We conducted a validation study of Carto-based 3D ultrasound (3D-US) and 3D-US merged with computed tomography (3D-Merge-CT) left atrium/pulmonary vein images. Under fluoroscopic guidance, 1361 mapping points (20 patients) with CFs and electrogram information were randomly acquired around the PVs. CF correlated weakly with the distance of mapping points from the 3D-Merge-CT (r = 0.27; P < .001) and 3D-US (r = 0.22; P < .001) surfaces but not with bipolar voltage (r = -0.01; P = .2400). Low CF (0-4 g) yielded points close to the 3D-US surface; moderate (5-9 g) and high CFs (10-20 g) generated points beyond the surface (0.1 ± 3.9, 1.4 ± 3.4, and 2.3 ± 3.4 mm; P < .05 for each). Low, moderate, and high CFs yielded points below, close to, and beyond the 3D-Merge-CT surface (-1.2 ± 3.7, 0.4 ± 3.0, and 1.0 ± 2.9 mm; P < .05 for each). Poor correlation between CF and the distance of mapping points from the 3D map surfaces and electrogram information shows the limitation of 3D mapping and electrogram information for predicting good contact. In addition, mapping seems to require far less CF than ablation requires.

Ultra-low voltage MEMS switch using a folded hinge structure

Abstract An ultra-low voltage microelectromechanical system (MEMS) switch for low-power integrated circuit (IC) applications is proposed, fabricated and demonstrated. The folded hinge structure allows a large beam structure to be suspended with a designed air gap, effectively suppressing unwanted deflection. The actuation voltage of the switch was measured to be 1.7 V, the lowest among electrostatic switches. There was no variation in the actuation voltage until 106 cyclic actuations, showing the stability of a low actuation voltage in electrostatic actuation for the first time. The contact resistance was around 12 Ω, caused by a low contact force below 1 μN despite an Au–Au contact.

Low-velocity impact behavior of Al 6061/SiC particulate metal matrix composites

This study addresses the effects of impact velocity (impact energy) and particle volume fraction and particle size on the impact behavior of particle-reinforced metal matrix composites (Al 6061/SiC). Their effects on the contact force and plastic dissipation histories, the residual stress, and plastic strain distributions were also analyzed. The impact velocity and particle volume fraction and particle size were found to have a significant effect. The contact forces and durations increased significantly with increasing impact velocity. The predicted peak contact forces were in minimal errors for lower impact velocities, whereas the predicted impact durations were slightly longer. The composite structures become stiffer when the particle volume fraction is increased. Consequently, the contact force was increased, whereas the impact durations were shortened. However, a larger particle size resulted in lower contact forces, but longer impact durations. Particle reinforced composites can dissipate more kinetic energy in case the particle volume fraction decreases and the particle size increases. Increasing impact velocity and particle volume fraction increased residual stress levels and the plastic strain. Increasing the particle size resulted in the residual stress distributions to become non-uniform but increases in the plastic deformations.

3P2-D03 床反力を用いた動作識別と認識(リハビリテーションロボティクス・メカトロニクス)

Optical motion capture systems, which are used in broad fields of research, are costly; they need large installation space and calibrations. We find difficulty in applying it in typical homes and care centers. Therefore we propose to use low cost contact force measurement systems to develop rehabilitation and healthcare monitoring tools. Here, we propose a novel algorithm for motion recognition using the feature vector from force data solely obtained during a daily exercise program. We recognized 7 types of movement of 2 candidates. The results show that the recognition rate of each motion has high score. The results also confirm that there is a clustering of each movement in personal exercises data thus that motion recognition is possible using inexpensive contact force measurement

In Vivo Contact Force Analysis and Correlation With Tissue Impedance During Left Atrial Mapping and Catheter Ablation of Atrial Fibrillation

The aim of this study was to evaluate in vivo contact force (CF) and the correlation of CF with impedance during left atrial 3-dimensional electroanatomical mapping and ablation. CF during point-by-point left atrial mapping was assessed in 30 patients undergoing atrial fibrillation ablation. Operators were blinded to the real-time CF data. Data were analyzed according to 11 predefined areas in the left atrial and 6 segments around the ipsilateral pulmonary veins. A total of 3475 mapping and 878 ablation points were analyzed. Median CF during mapping was 14.0g (6.5-26.2; q1-q3), ranging from 5.1g at the ridge to 29.8g at the roof. Median CF at the ridge and mitral isthmus were 5.1g and 6.9g, respectively. Extremely high CF ≥100g was noted in 24 points (0.7%). Median CFs during ablation around the right and left pulmonary veins were 22.8g (12.6-37.9; q1-q3) and 12.3g (6.9-30.2; q1-q3), respectively. The lowest median CFs were recorded at the anterior-superior and anterior-inferior segments of the left pulmonary veins (7.2g and 7.9g). Impedance values during mapping and impedance fall during ablation correlated with the applied CF (R(2)=0.16; P<0.001 and R(2)=0.04; P<0.001) although there was significant overlap. Excessively high and low CF values can be observed during left atrial mapping and ablation. The low CF obtained at the mitral isthmus and anterior segments of the left pulmonary veins may explain why reconnection after ablation occurs more frequently at these sites. CF and impedance do correlate; however, the impedance for a given CF ranges widely, limiting its use in clinical practice.

Instability of Contact Resistance in MEMS and NEMS DC Switches under Low Force: the Role of Alien Films on the Contact Surface

The metal contact is one of the most crucial parts in ohmic-contact microelectromechanical (MEMS) switches, as it determines the device performance and reliability. It has been observed that there is contact instability when the contact force is below a threshold value (minimum contact force). However, there has been very limited knowledge so far about the unstable electrical contact behavior under low contact force. In this work, the instability of Au-Au micro/nano-contact behavior during the initial stage of contact formation is comprehensively investigated for the first time. It has been found that the alien film on the contact surface plays a critical role in determining the contact behavior at the initial contact stage under low contact force. A strong correlation between contact resistance fluctuation at the initial contact stage and the presence of a hydrocarbon alien film on the contact surface is revealed. The enhancement of contact instability due to the alien film can be explained within a framework of trap-assisted tunneling.

Understanding of Initial Unstable Contact Behaviors of Au-to-Au Microcontact under Low Contact Force for Micro- and Nano-Electromechanical System Devices

The Au-to-Au micro/nano-contact behavior in unstable contact region during the initial stage of contact formation has been experimentally investigated under low contact force. The experimental results reveal that the asperity deformation process, which is conventionally observed in the stable region, could start from the early stage of contact formation in the unstable region. The fundamental mechanism for the instability of electrical conductance in the unstable region can be explained under a framework of trap-assisted tunneling at the contact interface.

Location and ratio of high and low contact force during left atrial mapping

Purpose: The aim of this study was to evaluate the location and the ratio of high/low contact force (CF) during left atrial (LA) mapping. Methods: CF during point-by-point LA mapping were assessed in 50 patients. In 30 patients, the operators were blinded to the CF during the procedure (Group A). In 20 patients, the CF was displayed to the operators (Group B). As a parameter of the catheter stability, relative standard deviation (RSD=standard deviation of CF*100 /mean CF) was calculated at each mapping point. Data were analyzed according to 11 predefined areas (Figure). In Group B, the optimal CF was defined to be 10-40g and the operators attempted to acquire points (pts) in this optimal range. We compared the CF and the catheter stability between 2 groups. Results: A total of 5866 mapping pts were analyzed (3467 pts in Group A and 2399 pts in Group B). Mean CF was 20±19g in Group A and 19±11g in Group B. Low CF 40g was noted at 414 pts (12%) in Group A and 67 pts (3%) in Group B (P 100g was noted at 22 pts (0.6%) in Group A, no CF>100g point was noted in Group B (P<.001). RSD was significantly lower in Group B than in Group A (30% vs 33%, P<.001), suggesting better catheter stability in Group B. Particularly in mitral isthmus and ridge areas, in Group B, CF was significantly higher (15±11g vs 10±10g, P<.001; 13±11g vs 8±9g, P<.001) and RSD was lower (32% vs 41%, P<.001; 27% vs 39%, P<.001) as compared to Group A. ![Figure][1] Figure 1. CF distribution and LA sites Conclusions: There are considerable number of mapping pts with high/low CF during CF-blinded procedure. CF sensing catheter appears to be helpful to avoid both unnecessary high and low CF, which may have clinical impact on the catheter ablation. [1]: pending:yes

Reaching in clutter with whole-arm tactile sensing

We begin this paper by presenting our approach to robot manipulation, which emphasizes the benefits of making contact with the world across the entire manipulator. We assume that low contact forces are benign, and focus on the development of robots that can control their contact forces during goal-directed motion. Inspired by biology, we assume that the robot has low-stiffness actuation at its joints, and tactile sensing across the entire surface of its manipulator. We then describe a novel controller that exploits these assumptions. The controller only requires haptic sensing and does not need an explicit model of the environment prior to contact. It also handles multiple contacts across the surface of the manipulator. The controller uses model predictive control (MPC) with a time horizon of length one, and a linear quasi-static mechanical model that it constructs at each time step. We show that this controller enables both real and simulated robots to reach goal locations in high clutter with low contact forces. Our experiments include tests using a real robot with a novel tactile sensor array on its forearm reaching into simulated foliage and a cinder block. In our experiments, robots made contact across their entire arms while pushing aside movable objects, deforming compliant objects, and perceiving the world.

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Background— Pulmonary vein isolation is the most prevalent approach for catheter ablation of paroxysmal atrial fibrillation. Long-term success of the procedure is diminished by arrhythmia recurrences occurring predominantly because of reconnections in previously isolated pulmonary veins. The aim of the EFFICAS I multicenter study was to demonstrate the correlation between contact force (CF) parameters during initial procedure and the incidence of isolation gaps (gap) at 3-month follow-up. Method and Results— A radiofrequency ablation catheter with integrated CF sensor (TactiCath, Endosense, Geneva, Switzerland) was used to perform pulmonary vein isolation in 46 patients with paroxysmal atrial fibrillation. During the ablation procedure, the operator was blinded to CF information. At follow-up, an interventional diagnostic procedure was performed to assess gap location as correlated to index procedure ablation parameters. At follow-up, 65% (26/40) of patients showed ≥1 gaps. Ablations with minimum Force–Time Integral (FTI) &lt;400 gs showed increased likelihood for reconnection ( P &lt;0.001). Reconnection correlated strongly with minimum CF ( P &lt;0.0001) and minimum FTI ( P =0.0007) at the site of gap. Gap occurrence showed a strong trend with lower average CF and average FTI. CF and FTI are generally higher on the right side, although the left anterior segment presents a unique challenge to achieve stable position with good CF. Conclusions— Minimum CF and minimum FTI values are strong predictors of gap formation. Optimal CF parameter recommendations are a target CF of 20 g and a minimum FTI of 400 gs for each new lesion.

A Low Contact Force Polishing System for Micro Molds that Utilizes 2-Dimensional Low Frequency Vibrations (2DLFV) with Piezoelectric Actuators (PZT) and a Mechanical Transformer Mechanism

This study proposes and develops a novel polishing system for micro molds which need high precision polishing, high aspect ratio of micro channel structure, or further miniaturization for micro channel structure. The proposed system has been named a “low contact force polishing system for micro mold utilizing 2-dimensional low frequency vibrations (2DLFV) with piezoelectric actuators (PZTs) and a mechanical transformer mechanism.” The system consists of 2DLFV with PZTs incorporated into the mechanical transformer structure, a low contact force loader, and a polishing tool. The shape of the polishing tool is flexible and can be changed depending on the complicatedness of the shape of the work. Several experiments are conducted to evaluate the performance of the polishing system. The evaluation reveals that a convex removal footprint can be easily achieved with the polishing system. The fact that the relationship between the removal depth and the polishing time suit Preston’s law well shows a stable polishing process is realized with the system. The polishing performances remains the same even if the shape of the polishing tool is changed. This indicates that the system can use polishing tools of a wide selection of shapes, which allows the system to polish a large variety of materials and most of the complicated shapes of metal structures, achieving a dramatic reduction in surface roughness. The plano raster polishing results also show the system to be well suited to the dwell time control polishing because the results show the removal footprint to be proportional to the dwell time and the defined raster path. All in all, the system is a versatile polishing system capable of achieving the intended objectives.

Effect of Atrial Fibrillation on Catheter-Tissue Contact During Antral Pulmonary Vein Isolation in Humans: Lower Contact Force at the Left Anterior Pulmonary Vein in Atrial Fibrillation Compared to Sinus or Paced Rhythm

Effect of Atrial Fibrillation on Catheter-Tissue Contact During Antral Pulmonary Vein Isolation in Humans: Lower Contact Force at the Left Anterior Pulmonary Vein in Atrial Fibrillation Compared to Sinus or Paced Rhythm

Collecting a comprehensive evidence base to monitor fracture rehabilitation: A case study

To determine the feasibility and potential role of combining radiostereometric analysis (RSA), gait analysis and activity monitoring in the follow-up of fracture patients. Two patients with similar 41B3 tibial plateau fractures were treated by open reduction internal fixation augmented with impaction bone grafting and were instructed to partial weight bear to 10 kg for the first six postoperative weeks. Fracture reduction and fixation were assessed by postoperative computer tomographic (CT) scanning. Both patients had tantalum markers inserted intra-operatively to monitor their fracture stability during healing using RSA and differentially loaded RSA (DLRSA) at 6 and 12 wk postoperatively. Gait analyses were performed at 1, 2, 6, and 12 wk postoperatively. Activity monitors were worn for 4 wk between the 2 and 6 wk appointments. In addition to gait analysis, knee function was assessed using the patient reported Lysholm scores, and doctor reported knee range of motion and stability, at 6 and 12 wk postoperatively. There were no complications. CT demonstrated that both fractures were reduced anatomically. Gait analysis indicated that Patient 1 bore weight to 60% of body weight at 2 wk postoperative and 100% at 6 wk. Patient 2 bore weight at 10% of body weight to 6 wk and had very low joint contact forces to that time. At 12 wk however, there was no difference between the gait patterns in the two patients. Patient 1 increased activities of moderate-vigorous intensity from 20 to 60 min/d between 2 and 6 postoperative weeks, whereas Patient 2 remained more stable at 20-30 min/d. The Lysholm scores were similar for both patients and did not improve between 6 and 12 wk postoperatively. DLRSA examination at 12 wk showed that both patients were comfortable to weight bear to 80 kg and under this weight the fractures displaced less than 0.4 mm. RSA measurements demonstrated over time fracture migrations of less than 2 mm in both cases. However, Patient 2, who followed the postoperative weight bearing instructions most closely, displaced less (0.3 mm vs 1.6 mm). This study demonstrates the potential of using a combination of RSA, gait analysis and activity monitoring to obtain a comprehensive evidence base for postoperative weight bearing schedules during fracture healing.

1A1-D05 床反力の特徴値を用いた動作認識(リハビリテーションロボティクス・メカトロニクス(1))

Optical motion capture systems, which are used in broad fields of research, are costly; they need large installation space and calibrations. We find difficulty in applying it in typical homes and care centers. Therefore we propose to use low cost contact force measurement systems to develop rehabilitation and healthcare monitoring tools. Here, we propose a novel algorithm for motion recognition using the feature vector from force data solely obtained during a daily exercise program. We recognized 7 types of movement of 2 candidates. The results show that the recognition rate of each motion has high score. The results also confirm that there is a clustering of each movement in personal exercise data, and a similarity of the clustering even for different candidates thus that motion recognition is possible using contact force data.

Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: A prospective case control study

Contact force (CF) sensing technology allows real time CF measurement during catheter ablation. We hypothesised that the use of CF technology during pulmonary vein isolation (PVI) for atrial fibrillation (AF) would translate into lower acute pulmonary vein (PV) reconnection rates. Symptomatic AF patients were treated in two groups, 'unblinded' and 'blinded', each containing 20 patients undergoing first time PVI. An irrigated radiofrequency CF sensing catheter was used in both groups. In the 'unblinded' group, the operator could view the CF value during mapping and ablation in real time. In the 'blinded group', the operator was 'blinded' to this information during the procedure, although the data were recorded. All 80 PVs were successfully isolated with exit and entrance block re-tested after 1h with adenosine. There was a significant association between blinding and the rate of acute PV reconnection. 17/80 (21%) of the PVs in the blinded subjects had a reconnection while 3/80 (4%) of the PVs in the unblinded subjects had a reconnection (p=0.001). Blinding the operator resulted in lower mean CF overall (11.6g (10.5, 12.9 g) vs. 14.4 g (13.3, 15.7 g); p=0.002). Sites where applied CF was significantly lower than others were usually the sites where reconnection occurred: these were the ridge between the left upper PV and appendage, and the right carina. CF data identified key areas where CF was poor. These were the areas of acute reconnection. Availability of real time CF information during PVI was associated with a significantly lower acute pulmonary vein reconnection rate.

How to achieve durable pulmonary vein isolation: Use the force

How to achieve durable pulmonary vein isolation: Use the force