Visual, tactile, and contact force feedback: Which one is more important for catheter ablation? Results from an in vitro experimental study

Luigi Di Biase, Alessandro Paoletti Perini, Prasant Mohanty, Alex S. Goldenberg, Gino Grifoni, Pasquale Santangeli, Francesco Santoro, Javier E. Sanchez, Rodney Horton, G. Joseph Gallinghouse, Sergio Conti, Sanghamitra Mohanty, Shane Bailey, Chintan Trivedi, Aditi Garg, Aaron P. Grogan, Dan T. Wallace, Luigi Padeletti, Vivek Reddy, Pierre JaisMichelle Haïssaguerre, Andrea Natale

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background During radiofrequency ablation, effective contact is crucial in determining lesions efficacy. Objective The purpose of this study was to compare operators' ability to assess contact pressure using visual and tactile feedbacks together or alone in an experimental model. Methods In a in vitro experimental setup replicating manual catheter manipulation and recording the applied force, evaluators were asked to identify three levels of force (first, ablation, and maximum contact) as the catheter contacted the tissue model using (1) visual feedback only by fluoroscopy, "blinded" to touch; (2) tactile feedback only, blinded to fluoroscopy; and (3) both tactile and visual feedback together. The latter was regarded as reference. The experiment was repeated using a catheter force sensing technology during robotic navigation. Results During manual navigation, tighter association was shown for the visual method than for the tactile method: median difference with reference: first contact -1 (P =.97) vs -2 (P =.90); ablation contact 2 (P =.1) vs -7 (P =.03); maximum contact 2 (P =.06) vs -28 (P =.02). Bland-Altman plot and Deming regression confirmed for the visual method the good agreement with reference and the absence of bias at any level and showed for the tactile higher values and proportional bias that reached statistical significance at ablation and maximum contact. During robotic navigation, agreement was higher for the tactile than for the visual only method. Conclusion During manual navigation, visual feedback alone is in better agreement with the reference compared to the tactile only approach. During robotic navigation, agreement is looser for the visual only approach. More objective feedback of contact pressure during ablation procedures is desirable.

Original languageEnglish (US)
Pages (from-to)506-513
Number of pages8
JournalHeart Rhythm
Issue number3
StatePublished - Mar 2014


  • Ablation
  • Atrial fibrillation
  • Complications
  • Contact force
  • Fluoroscopy
  • Impedance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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