Remote Robotic System Research Articles

Enhancement of Stabilization Control in Remote Robot System with Force Feedback

In this paper, we deal with a remote robot system in which a user can operate an industrial robot with a force sensor at a remote location by using a haptic interface device. We apply a method using the wave filter together with the phase control filter which was previously proposed by the authors to the remote robot system for stabilization control. We also propose a method to enhance the haptic quality. By experiment, we demonstrate the effectiveness of the proposed method. We compare the proposed method with the conventional method quantitatively and clarify which domains the proposed method is applied to more effectively.

Bilateral human-in-the-loop tele-haptic interface for controlling a robotic manipulator

Effective human-robot interaction is a factor deemed necessary for control of industrial robots and manipulators. Fine manual control and calibration tasks for an industrial manipulator can be daunting for human operators. In this paper, the authors proposed a bilateral haptic interface for controlling a robotic manipulator using a haptic device. This allows the human operator to intuitively jog and fell the manipulator from a remote station. The proposed system consists of slave robot manipulators controlled by the master haptic devices that can give haptic feedback to the user when the slave robot touches rigid and deformable surfaces. Such a human-in-the-loop approach to control a remote robotic system offers a pragmatic solution when the robotic system is operating under dynamically changing environments and dexterous tasks. The inclusion of haptic feedback offers the potential to augment the operators' control task and overcome the limitations of visual perception within the robots operating environment.

Design and evaluation of safety operation VR training system for robotic catheter surgery.

A number of remote robotic catheter systems have been developed to protect physicians from X-ray exposure in endovascular surgery. However, the teleoperation prevents the physicians sensing the force directly which may easily result in healthy vessels injured. To realize the safe operation, a tissue protection-based VR training system has been developed in this paper to prevent collateral damage by collision. The integrated VR simulator cannot only remind the novice possible collisions by visual signs, but also cooperate with the newly designed tissue protection mechanism to remit collision trauma beforehand. Such mechanism exploits the diameter variable pulley in order to implement the safe interaction between catheter and vasculature. To testify the effectiveness of the tissue protection in training system, we invited four non-medical students to participate the successive 5days training session. The evaluation results show that the average impingement distance (representing tissue damage) to vascular wall has been reduced to 0.6mm, and the collision frequency is greatly decreased which implies the realization of relative safe catheterization.

The Pransky interview: Dr Yulun Wang, Founder and CEO of InTouch Health

Purpose – The following paper is a “Q & A interview” conducted by Joanne Pransky of Industrial Robot Journal as a method to impart the combined technological, business and personal experience of a prominent, robotic industry engineer-turned entrepreneur regarding the evolution, commercialization and challenges of bringing a technological invention to market. Design/methodology/approach – The interviewee is Dr Yulun Wang, an inventor, self-taught entrepreneur, business leader and world-renowned authority on robotics and health care. Dr Wang shares his successful three-decade journey that began with researching the market needs and aligning himself with medical experts, followed by pioneering robotic solutions specifically for the health care industry. In the process, Dr Wang founded and spearheaded both a public and private robotics company. Findings – Dr Yulun Wang received a BSc and an MSc in Computer Science, and a PhD in Electrical Engineering, from the University of California, Santa Barbara (UCSB). After teaching at UCSB for a few years, with a grant he won from NASA, Dr Wang founded Computer Motion, Inc. in 1989 and conducted research on endoscopic robots. Computer Motion went public in 1997 and later merged with its competitor, Intuitive Surgical (NASDAQ:IRSG) in 2003 to forge the multi-billion dollar surgical robotics industry. Dr Wang founded InTouch Technologies (d.b.a. InTouch Health), in 2002, named one of the fastest-growing biomedical companies in the USA by INC Magazine. Originality/value – Dr Wang launched his career at the intersection of health care and technology with his invention of the voice-controlled robotic arm AESOP, the first US Food and Drug Administration (FDA)-cleared surgical robot. His next generation ZEUS robotic surgical system (ZRSS), was cleared by the FDA in 2001. Also in 2001, ZRSS was used in the world’s first telesurgery, as surgeons in New York controlled the arms of the Zeus to perform a cholecystectomy on a patient in Strasbourg, France, via a high-speed fiber optic supplied by France Telecom. This led Dr Wang to found InTouch Health, a company that pioneers remote presence robot systems that enable health care professionals to provide more effective and efficient health care. Dr Wang has received multiple other entrepreneurship and leadership awards, including being elected to the prestigious ranks of the National Academy of Engineering in 2011. He is the author of over 50 scientific publications, and holds over 100 patents registered in his name. Dr Wang serves on several boards, including the American Telemedicine Association (ATA) Board of Directors, where he also serves as an officer.

Visual and Manual Control for Human-Robot Teleoperation

In an effort to assess simple control modalities for a remote robotic system, this study explores and tests the suitability of four interfaces for teleoperation in human-robot interaction. For a pick-and-place task, users were asked to select targets and locations using eye tracking (activated by either a mouse click or dwell time), a touchscreen, or a standard computer mouse. Contrary to their expectations, the authors found that eye-tracking-based interaction, especially when paired with manual-click selection, was generally slower and was perceived as more difficult than the mouse and touchscreen interfaces. Conversely, as predicted, they found evidence that eye tracking with dwell selection was less prone to interference caused by a secondary manual task.

Adaptive teleoperation using intelligent dynamic voting

This paper addresses the design of an adative teleoperation framework for spatially displaced robotics. Although teleoperation controllers have been optimized and frameworks developed for single user single robot teleoperation, the same cannot be said for multi-user control of a single remote agent. Typical collaborative teleoperation consists of a group of people working on a single remote robotic system with a user voting interface to decide on the commands sent to the robot. These are majority based systems and just like in a democracy, problems occur. This research is focussed on a system that uses an intelligent and adaptive dynamic voting paradigm in order to enable adaptive teleoperation.

MP18-09 ROBOTIC FLEXIBLE URETERORENOSCOPY, FOR THE TREATMENT OF KIDNEY STONES

You have accessJournal of UrologyStone Disease: Therapy II1 Apr 2014MP18-09 ROBOTIC FLEXIBLE URETERORENOSCOPY, FOR THE TREATMENT OF KIDNEY STONES Jens Rassweiler, Ahmet Yaser Muslumanoglu, Zafer Tokatli, Turhan Caskurlu, Kemal Sarica, Yasar Ozgok, Abdullah Armagan, Mut Safak, Ali Ihsan Tasci, Bulent Erkurt, Gurdal Inal, and Remzi Saglam Jens RassweilerJens Rassweiler More articles by this author , Ahmet Yaser MuslumanogluAhmet Yaser Muslumanoglu More articles by this author , Zafer TokatliZafer Tokatli More articles by this author , Turhan CaskurluTurhan Caskurlu More articles by this author , Kemal SaricaKemal Sarica More articles by this author , Yasar OzgokYasar Ozgok More articles by this author , Abdullah ArmaganAbdullah Armagan More articles by this author , Mut SafakMut Safak More articles by this author , Ali Ihsan TasciAli Ihsan Tasci More articles by this author , Bulent ErkurtBulent Erkurt More articles by this author , Gurdal InalGurdal Inal More articles by this author , and Remzi SaglamRemzi Saglam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.771AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureterorenoscopy (fURS) has rapidly gained popularity in the treatment of renal stones during the last decade. With increasing indications and utilization efforts concentrate on increased maneuverability and durability of scopes while decreasing surgeons' fatigue and radiation exposure. After the safety tests in pigs and maneuverability tests on the kidney model of Minnesota University, we planned to search safety and effectivity of the new «Remote robotic control system for flexible Ureterorenoscopy» called «Roboflex Avicenna» (ELMED, Turkey). METHODS After having the informed consents, we treated 42 stones robotically and 18 stones manually as a control group. All patients were suitable for fURS stone treatment from ten institutions were enrolled in to the study. Routine preoperative tests and imaging were performed to all patients. Additionally volume of each stone, calculated by a special software of CT. After insertion of a ureteral access sheath, videoscope (FlexXC Storz, Germany) was introduced into the sheath manually. Then the scope was connected to the Roboflex, and the time for this procedure had been recorded. Console and chair of Roboflex, adjusted ergonomically. Deflection can be performed by manipulating the right handle similar to standart fURS. Precise deflection provided from the whell on the console. The rotation and forward and backward movement can be controlled by left handle. Ureterorenoscopic exploration of all calyceal systems were performed and stones were fragmented using the users own laser devices. Fragments smaller than 1-2 mm were left for spontaneous passage. The fragmentation time recorded and the fragmented volume per minute was calculated. At the end of the procedures, ureteral j stents were placed whenever indicated. RESULTS Patients age was between 68 – 6 years old. Mean Stone Volume was 1568 cubicmm (432-4085 cubicmm). Mean connection time to the Roboflex was 57 seconds, but in an experienced center after 14 cases it decreased to 44 seconds. Mean fragmented volume per minute was 36 cubicmm/min for manual fURS and 29 cubicmm/min for robotic fURS, but it increased to 33 cubicmm/min for the user with a 14 cases of experience. Stone-free status including fragments up to 2mm as controlled with plain x-ray on day 1 was achieved in all cases. Fever not exceeding one day was seen in 2 patients. There were no damage of the kidney or urinary system. CONCLUSIONS Robot assisted flexible ureterorenoscopy using Roboflex has been detected as a safe and effective treatment method. It offers performing the fURS procedure out of radiation exposure area while sitting. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e207 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jens Rassweiler More articles by this author Ahmet Yaser Muslumanoglu More articles by this author Zafer Tokatli More articles by this author Turhan Caskurlu More articles by this author Kemal Sarica More articles by this author Yasar Ozgok More articles by this author Abdullah Armagan More articles by this author Mut Safak More articles by this author Ali Ihsan Tasci More articles by this author Bulent Erkurt More articles by this author Gurdal Inal More articles by this author Remzi Saglam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Tracking and replication of hand movements by teleguided intelligent manipulator robot

SUMMARYIn this paper, a new method is presented that allows an intelligent manipulator robotic system to track a human hand from far distance in 3D space and estimate its orientation and position in real time with the goal of ultimately using the algorithm with a robotic spherical wrist system. In this proposed algorithm, several image processing and morphology techniques are used in conjunction with various mathematical formulas to calculate the hand position and orientation. The proposed technique was tested on Remote teleguided virtual Robotic system. Experimental results show that proposed method is a robust technique in terms of the required processing time of estimation of orientation and position of hand.

Remote robotic assembly guided by 3D models linking to a real robot

This paper presents a 3D model-driven remote robotic assembly system. It constructs 3D models at runtime to represent unknown geometries at the robot side, where a sequence of images from a calibrated camera in different poses is used. Guided by the 3D models over the Internet, a remote operator can manipulate a real robot instantly for remote assembly operations. Experimental results show that the system is feasible to meet industrial assembly requirements with an acceptable level of modelling quality and relatively short processing time. The system also enables programming-free robotic assembly where the real robot follows the human's assembly operations instantly.

Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome

Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists. In this pilot study, CPVI combined with LAI-ablation were performed using a RNS and 3D-mapping system in 42 patients with persistent (n = 24, 57.1 %) or longstanding persistent AF. Ablation was performed using either a 3.5 mm irrigated tip catheter (ITC) with 6 (group-A, n = 16; max. 40 W, contact force 10-40 g) or (after a steam pop occurred in one patient) with a 4 mm ITC with 12 irrigation holes (group-B, n = 26; max. 30 W, contact force 10-30 g). Epicardial ablation was performed manually whenever bidirectional LAI-block could not be obtained with a maximum of 20 endocardial RF-applications. LAI-conduction block was achieved in all patients using RNS; in six patients (14.3 %), additional epicardial ablation was required to achieve LAI-block. A steam pop occurred during LAI-ablation resulting in cardiac tamponade in one patient in group-A. After a median follow-up period of 21 months, arrhythmia recurrence was seen in in 23/42 patients (18 patients with AF and 5 patients with atrial tachycardia) and repeat procedure was performed in 12 (28.6 %) patients; recovered LAI-conduction was found in 5/12 (41.7 %) patients. The RNS-group was compared to a historical group of 20 patients with manual LAI-ablation. Using RNS, LAI-block was more often achieved (42 (100 %) vs 16 (80 %), p < 0.01) and epicardial ablation was required in a significantly smaller number of patients (6 (14.3) vs 10 (50 %), p < 0.01). LAI-ablation using RNS appears to be feasible in all patients. At repeat procedure, LAI-conduction can frequently occur; power and contact-force adaption appears to be mandatory to reduce the risk of complications. Using RNS, instead of a manual approach for LAI-line ablation may facilitate creation of a bidirectional LAI-block.

An Anticipative Control Approach and Interactive GUI to Enhance the Rendering of the Distal Robot Interaction with its Environment during Robotized Tele-Echography

Performing a robotized telemedicine act via specific networks brings forth the issue of transparency in order to enable the operator, e.g. the medical ultrasound specialist, to safely and accurately perform bilateral tele-operation tasks despite the long time delays inherent to the communication link. To counter these effects, two strategies are combined to improve, at the operator site, the rendering of the interactions between the remote robotic systems with its environment (i.e. the patient), and the control of the robot’s orientation at the operator site. The first approach is the development of a new control architecture based on an internal model providing an anticipated value of the distant environment stiffness; it is complemented with a graphic user interface (GUI) which provides the expert with the real-time relative position of the haptic probe with the robot’s end effector for better tele-operated control. These combined strategies provide the expert with an improved interactive tool for tele-diagnosis.

Mitral Isthmus Ablation is Feasible, Efficacious, and Safe Using a Remote Robotic Catheter System

There are limited data on the use of a remote robotic catheter system (RCS) for mitral isthmus (MI) ablation. This single-center, prospective, matched control study included 45 patients who underwent atrial fibrillation ablation using a remote RCS compared to 45 patients who underwent conventional ablation. All patients had circumferential pulmonary vein isolation (PVI), roof, and MI ablation. There were no significant differences in baseline clinical characteristics. There were no significant differences in MI block (RCS: 44/45 [98%] vs 43/45 [96%], P = 1.0), roof block (RCS: 45/45 [100%] vs 44/45 [98%], P = 1.0), and PVI (RCS: 45/45 [100%] vs 45/45 [100%], P = 1.0). Ablation and procedural times were similar in both arms. Using RCS, mean total MI ablation and procedure times were 13 ± 6 minutes and 23 ± 15 minutes, respectively. Coronary sinus (CS) ablation was significantly less in the RCS arm (48% vs 72%, P = 0.03). It was possible to "drive" the ablation catheter into the distal CS using the RCS in 19/22 (86%) patients. There was a significant trend of reduction in mean MI ablation (P = 0.008) and procedural times (P = 0.004) over the course of the study period. There was a significant reduction in fluoroscopy time in the RNS arm (33 ± 17 minutes vs 49 ± 20 minutes, P = 0.0004). It is feasible and safe to use a remote RCS for MI ablation, including "driving into the CS." MI block was achieved in 98% with a significant reduction in the need for CS ablation (48%). There is a short learning curve.

Design of Remote Control Robot System

A remote control robot system is designed, and the operator uses the remote control radio transmitter module for remote operation, and after the radio receiver module receiving the signal, it can control the movements of the robot by the PLC instructions. The software system used STEP 7 Micro WIN SP6 as development platform to prepare the software program, and designed the robot hardware with the use of electronic circuit knowledge. The results show that the remote robot system is successful, and it can complete a variety of actions according to requires.

Remote robotic underwater grinding system and modeling for rectification of hydroelectric structures

A submersible grinding robot has been designed to automate the dam gate metallic structure repair process. In order to measure and control the amount of material removed during the process, an empirical approach for modeling the material removal rate (MRR) of the underwater grinding application is proposed and presented in this paper. The objective is to determine the MRR in terms of the process parameters such as cutting speed and grinding power over a range of variable wheel diameters. Experiments show that water causes drag and a significant loss of power occurs during grinding. An air injector encasing the grinding wheel has been prototyped, and it is shown that power loss can be reduced by up to 80%. A model, based on motor characterization and empirical relations among system and process parameters, is developed for predicting MRR which will be used for the robotic grinding control system. A validation is carried out through experiments, and confirms the good accuracy of the model for predicting the depth of cut for underwater grinding. A comparative study for dry and underwater grinding is also conducted through experiments and shows that the MRR is higher for underwater grinding than in dry conditions at low cutting speeds. Highlights? Underwater grinding process models based on MRR are developed. ? A 3-linear axis underwater grinding robot was prototyped and tested. ? The grinding models were experimentally validated. ? The work allows a good understanding of underwater grinding mechanism on power consumption. ? The models are intended to be integrated in a robotic underwater grinding system.

Emerging technologies for image guidance and device navigation in interventional radiology

Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures.

Robot-Assisted Stenting of a High-Grade Anastomotic Pulmonary Artery Stenosis Following Single Lung Transplantation

To report robot-assisted stenting of a stenosis at the pulmonary artery anastomosis following lung transplantation, a rare complication that conveys poor prognosis even after surgical correction. The technique is illustrated in a 72-year-old man with end-stage lung disease who received a left single lung transplant. On postoperative day 54, he was evaluated for recurrent dyspnea on exertion that was due to a severe stenosis at the site of the pulmonary artery anastomosis. Balloon angioplasty was performed, and a 10-mm stent was deployed, with marked clinical improvement. Fourteen months later, he presented with recurrent symptoms due to in-stent restenosis. Multiple attempts at catheterization and balloon angioplasty of the stent failed. Due to the technical difficulty involved in maneuvering the balloon while maintaining stability, it was decided to repeat the angioplasty with the assistance of a Hansen Sensei remote robotic navigation system. The robotic arm markedly enhanced stability and facilitated successful navigation of the stented site. A 16-mm-diameter Wallstent was placed through the previously placed balloon-expandable stent and postdilated. A remote robotic catheter navigation system was able to assist stenting of an anastomotic pulmonary artery stenosis following failure of conventional interventional techniques.

Prevention of oesophageal injury during catheter ablation of atrial fibrillation: is monitoring of oesophageal temperature the solution?

This editorial refers to ‘Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system’ by A. Rillig et al. , Europace 2010;12:655–61. Atrio-oesophageal fistula is among the most dangerous complications of interventional treatment of atrial fibrillation. The complication was first observed during intraoperative radiofrequency ablation of atrial fibrillation1 but subsequently also reported after catheter based radiofrequency ablation of atrial fibrillation.2 Atrio-oesophageal fistula is associated with high mortality3 even if the correct diagnosis is made relatively early. However, the diagnosis of the complication often is delayed because of the significant time delay of its occurrence after the ablation procedure (which mostly is 1–4 weeks) and unspecific initial symptoms.3,4 The mechanism most likely leading to atrio-oesophageal fistula after radiofrequency ablation of atrial fibrillation is the induction of thermal oesophageal injury during the ablation procedure; this pathophysiologic pathway could recently be observed in a patient who declined intervention after diagnosis of atrio-oesophageal fistula.4 The incidence of oesophageal injury after radiofrequency ablation of atrial fibrillation has been described between 5% and almost 50%5–7 depending on the radiofrequency power settings and ablation strategies. After the initial injury of the oesophagus, inflammation, and tissue necrosis promoted by the biological milieu in the oesophagus seem to pave the way for the occurrence of atrio-esophagel fistula. However, it is unclear which factors determine the progression of the frequently observed oesophageal lesion to the relatively rare but …

Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system

Oesophageal lesions (EL), a potential complication after pulmonary vein isolation (PVI), have been described recently. A new remote robotic navigation system (RNS; Hansen Medical) provides enhanced catheter stability along with more effective lesion placement. The aim of this prospective study was to evaluate temperature monitoring and incidence of EL when using RNS with an irrigated tip radiofrequency catheter for PVI. Circumferential PVI using RNS was performed in 73 patients (pts) with paroxysmal (n = 46, 63%) and persistent atrial fibrillation. An oesophageal temperature probe was placed in 58 (79.5%) pts and was integrated in the 3D-map (NavX). Power was limited to 25 W at the posterior wall, and in the case of an increase in temperature power was limited to 20 W. Endoscopy was performed in 42 pts within 24 h after PVI. In 44 of 58 (75.9%) pts, a significant rise in temperature (>39 degrees C) was observed. In 6 of 42 (14.3%) pts, an EL was found during endoscopy. In patients with EL, the body mass index (BMI) was significantly lower than in pts without EL (24.1 +/- 2.0 vs. 29.0 +/- 5.8, P = 0.047). The BMI of all patients with EL was <26, whereas all patients without EL had a BMI above 26. The EL showed brisk healing after re-endoscopy within 2 weeks in all pts. In patients undergoing PVI using the RNS, the incidence of EL is 14.3% when using power settings comparable to settings used in manual ablation. Patients with lower BMI (<26) are at higher risk for EL.

Development of Remote Control System for Bridge Inspection using Robot and Digital Image Processing Technology

After 1994, highway bridges are maintained under the Special Law on Structure Safety in Korea. To keep a structure good condition, inspection of the structure has to be performed periodically. The inspection is hard work and needs a lot of time an many inspectors to inspect the structure that is important or damaged. Generally, this contains subjectivity of inspector, and so the result ofinspection is not objective and reliable. And the inspection has a limit to only the bridges that access is possible to bottom of it. The purpose of this study is to develop new inspection technique and equipment to solve above problems and to provide convenient inspection work. The new inspection method may be able to make the inspection of bridge deck more efficient and reliable. This new inspection technique makes inspection job scientific and systematic. Digital image processing technology and Robotics are used in this inspection system. This study can be divided into three parts. 1) A studyon development of digital image processing system. This system can stitch each image and detect cracks of bottom of bridge deck. Also, it can extract an investigation drawing from the picture. 2)Development of remote controlled robot system with camera and boom system. Pictures of bottom of bridge deck can be captured easily by using robot controlled on the deck remote. 3) A study on construction of Database of digital images obtained by remote controlled robot system. We can compare the pictures obtained periodically. So we can find changes of surface and crackpropagations from the images. As a result of this study, inspection work with naked eye could replace with the new inspection system. The system is manufactured including digital camera module, remote controlled robot, boom system and vehicle, and global positioning system. ©2010 International Journal of Computer Applications (0975 8887)

Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study

Persistent iatrogenic atrial septal defect (iASD) after transseptal puncture for pulmonary vein isolation (PVI) has been described recently as a complication of PVI. No data exists evaluating systematically the incidence and clinical implications of iASDs after PVI using a remote robotic navigation system (RNS) with sheaths with a distinct larger outer diameter. In this prospective study, 40 patients with either paroxysmal (n = 22, 55%) or persistent symptomatic atrial fibrillation were treated with circumferential PVI using an RNS. In all patients, a single-puncture, double-transseptal approach was used to access the left atrium. Transoesophageal echocardiography was performed before and the day after PVI as well as after a 3 and 6 months follow-up (FU). The day after ablation an iASD was detected in 38 of 40 (95%) patients with a mean diameter of 3.45 +/- 1.5 mm. At 6-month FU, the iASDs were closed in 30 of 39 (78.9%) patients. During the 6-month FU period, no patient died or suffered from cerebral or cardiac embolism. After a single-puncture, double-transseptal approach for PVI using the RNS, iASDs show a high spontaneous closure rate of 78.9% after a 6-month FU period. Persistent iASDs following PVI with the RNS are not associated with an increased rate of paradoxical embolism or with relevant shunting.