A Soft Robot Guides Pacemaker Lead Placement

Over 2% of the adult population in the United States is currently managing heart failure [1]. One form of treatment is cardiac resynchronization therapy in the form of biventricular pacing, in which a pacemaker’s electrical lead is delivered into the coronary sinus (CS) by way of the right atrium (RA) (Fig 1 a), stimulating more efficient cardiac contraction [2]. However, difficulties in CS cannulation have been observed in up to a quarter of patients, owing to challenging anatomy, unstable lead positioning, and CS dissection [3], [4]. Ultimately, current methods of CS cannulation may expose patients to nearly thirty minutes of X-ray fluoroscopy [5]. Several factors make it challenging to navigate a catheter within the beating heart and precisely position a lead within a coronary venous target. Often, interventional catheters have limited degrees of freedom, and are relatively unstable due to high flexibility. Robotic systems have attempted to add degrees of freedom and increase sta- bility [6], but elastic instabilities and frictional losses may hinder their ability to reach distant targets. Alternatively, soft robots possess material compliance for safe contact with delicate anatomy, and fluidic actuation increases stability and dexterity for interaction with distant targets. This study explores the development and validation of a soft robotic system for CS lead placement, building upon previous works by the authors [7], [8].