{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T09:06:58Z","timestamp":1777799218264,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,19]],"date-time":"2024-05-19T00:00:00Z","timestamp":1716076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome\/EPSRC Centre for Medical Engineering","award":["WT203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT203148\/Z\/16\/Z"]}]},{"name":"British Heart Foundation (BHF) Centre of Excellence","award":["WT203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT203148\/Z\/16\/Z"]}]},{"name":"Department of Health and Social Care (DHSC)","award":["WT203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT203148\/Z\/16\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Robotics"],"abstract":"<jats:p>Atrial fibrillation, the most prevalent cardiac arrhythmia, is treated by catheter ablation to isolate electrical triggers. Clinical trials on robotic catheter systems hold promise for improving the safety and efficacy of the procedure. However, expense and proprietary designs hinder accessibility to such systems. This paper details an open-source, modular, three-degree-of-freedom robotic platform for teleoperating commercial ablation catheters through joystick navigation. We also demonstrate a catheter-agnostic handle interface permitting customization with commercial catheters. Collaborating clinicians performed benchtop targeting trials, comparing manual and robotic catheter navigation performance. The robot reduced task duration by 1.59 s across participants and five trials. Validation through mean motion jerk analysis revealed 35.2% smoother robotic navigation for experts (\u226510 years experience) compared to the intermediate group. Yet, both groups achieved smoother robot motion relative to the manual approach, with the experts and intermediates exhibiting 42.2% and 13.6% improvements, respectively. These results highlight the potential of this system for enhancing catheter-based procedures. The source code and designs of CardioXplorer have been made publicly available to lower boundaries and drive innovations that enhance procedure efficacy beyond human capabilities.<\/jats:p>","DOI":"10.3390\/robotics13050080","type":"journal-article","created":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T03:26:27Z","timestamp":1716261987000},"page":"80","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["CardioXplorer: An Open-Source Modular Teleoperative Robotic Catheter Ablation System"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9611-6514","authenticated-orcid":false,"given":"Zhouyang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1594-1594","authenticated-orcid":false,"given":"Aya Mutaz","family":"Zeidan","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2243-6855","authenticated-orcid":false,"given":"Yetao","family":"He","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7485-6440","authenticated-orcid":false,"given":"Lisa","family":"Leung","sequence":"additional","affiliation":[{"name":"St. George\u2019s Hospital, NHS Foundation Trust, London SW17 0QT, UK"}]},{"given":"Calum","family":"Byrne","sequence":"additional","affiliation":[{"name":"Cardiology Department, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}]},{"given":"Sachin","family":"Sabu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}]},{"given":"Yuanwei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"given":"Zhiyue","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7266-2084","authenticated-orcid":false,"given":"Steven E.","family":"Williams","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH8 9YL, UK"}]},{"given":"Lukas","family":"Lindenroth","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"given":"Jonathan","family":"Behar","sequence":"additional","affiliation":[{"name":"Cardiology Department, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}]},{"given":"Christopher Aldo","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"},{"name":"Cardiology Department, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}]},{"given":"John","family":"Whitaker","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"},{"name":"Cardiology Department, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London SE1 7EH, UK"}]},{"given":"Aruna","family":"Arujuna","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"given":"Richard","family":"Housden","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4707-7318","authenticated-orcid":false,"given":"Kawal","family":"Rhode","sequence":"additional","affiliation":[{"name":"Department of Surgical & Interventional Engineering, School of Biomedical Engineering & Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: The CABANA randomized clinical trial","volume":"321","author":"Packer","year":"2019","journal-title":"JAMA"},{"key":"ref_2","first-page":"632","article-title":"News from the Heart Rhythm Society: 2012 HRS\/EHRA\/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation. Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS)","volume":"4","author":"Calkins","year":"2012","journal-title":"EP Eur."},{"key":"ref_3","first-page":"195","article-title":"Atrial fibrillation: The current epidemic","volume":"14","author":"Morillo","year":"2017","journal-title":"J. Geriatr. Cardiol. JGC"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1586\/17434440.2015.1052406","article-title":"Robotic navigation for catheter ablation: Benefits and challenges","volume":"12","author":"Aagaard","year":"2015","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/jce.14380","article-title":"Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches","volume":"31","author":"Bassil","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1016\/j.jacc.2003.07.023","article-title":"Magnetic guidance system for cardiac electrophysiology: A prospective trial of safety and efficacy in humans","volume":"42","author":"Faddis","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1161\/CIRCULATIONAHA.106.677369","article-title":"View-synchronized robotic image-guided therapy for atrial fibrillation ablation: Experimental validation and clinical feasibility","volume":"115","author":"Reddy","year":"2007","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"30051","DOI":"10.1109\/JSEN.2023.3320356","article-title":"The critical technologies of vascular interventional robotic catheterization: A Review","volume":"23","author":"Ren","year":"2023","journal-title":"IEEE Sens. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s10840-013-9791-9","article-title":"First experience with a novel robotic remote catheter system: Amigo\u2122 mapping trial","volume":"37","author":"Khan","year":"2013","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102584","DOI":"10.1016\/j.media.2022.102584","article-title":"A survey of catheter tracking concepts and methodologies","volume":"82","author":"Ramadani","year":"2022","journal-title":"Med. Image Anal."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1089\/end.2016.0396","article-title":"Development of a classification scheme for examining adverse events associated with medical devices, specifically the DaVinci surgical system as reported in the FDA MAUDE database","volume":"31","author":"Gupta","year":"2017","journal-title":"J. Endourol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"114380","DOI":"10.1016\/j.sna.2023.114380","article-title":"Development of a soft robotic catheter for vascular intervention surgery","volume":"357","author":"Nguyen","year":"2023","journal-title":"Sens. Actuators A Phys."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1109\/LRA.2017.2676351","article-title":"A contact-aided asymmetric steerable catheter for atrial fibrillation ablation","volume":"2","author":"Gao","year":"2017","journal-title":"IEEE Robot. Autom. Lett."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.sna.2016.06.010","article-title":"A survey on actuators-driven surgical robots","volume":"247","author":"Le","year":"2016","journal-title":"Sens. Actuators A Phys."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Nguyen, C.C., Teh, T., Thai, M.T., Phan, P.T., Hoang, T.T., Low, H., Davies, J., Nicotra, E., Lovell, N.H., and Do, T.N. (2022, January 23\u201327). Bidirectional Soft Robotic Catheter for Arrhythmia Treatment. Proceedings of the 2022 International Conference on Robotics and Automation (ICRA), Philadelphia, PA, USA.","DOI":"10.1109\/ICRA46639.2022.9811988"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11370-020-00311-0","article-title":"A review of magnetic actuation systems and magnetically actuated guidewire-and catheter-based microrobots for vascular interventions","volume":"13","author":"Hwang","year":"2020","journal-title":"Intell. Serv. Robot."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zeidan, A.M., Xu, Z., Mower, C.E., Wu, H., Walker, Q., Ayoade, O., Cotic, N., Behar, J., Williams, S., and Arujuna, A. (June, January 29). Design and Development of a Novel Force-Sensing Robotic System for the Transseptal Puncture in Left Atrial Catheter Ablation. Proceedings of the 2023 IEEE International Conference on Robotics and Automation (ICRA), London, UK.","DOI":"10.1109\/ICRA48891.2023.10160254"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cercenelli, L., Bortolani, B., and Marcelli, E. (2017). CathROB: A highly compact and versatile remote catheter navigation system. Appl. Bionics Biomech., 2017.","DOI":"10.1155\/2017\/2712453"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1109\/MRA.2016.2639067","article-title":"The soft robotics toolkit: Strategies for overcoming obstacles to the wide dissemination of soft-robotic hardware","volume":"24","author":"Holland","year":"2017","journal-title":"IEEE Robot. Autom. Mag."},{"key":"ref_20","unstructured":"Faure, F., Duriez, C., Delingette, H., Allard, J., Gilles, B., Marchesseau, S., Talbot, H., Courtecuisse, H., Bousquet, G., and Peterlik, I. (2012). Soft Tissue Biomechanical Modeling for Computer Assisted Surgery, Springer."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1080\/01691864.2017.1395362","article-title":"Software toolkit for modeling, simulation, and control of soft robots","volume":"31","author":"Coevoet","year":"2017","journal-title":"Adv. Robot."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev-control-062322-100607","article-title":"An Overview of Soft Robotics","volume":"6","author":"Yasa","year":"2023","journal-title":"Annu. Rev. Control. Robot. Auton. Syst."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Xu, Z., Zeidan, A.M., He, Y., Leung, L., Byrne, C., Sabu, S., Wu, Y., Chen, Z., Williams, S.E., and Lindenroth, L. (2024, April 11). CardioXplorer: An Open-Source Modular Teleoperative Robotic Catheter Ablation System. Available online: https:\/\/github.com\/ZhouyangX\/CardioXplorer.","DOI":"10.3390\/robotics13050080"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2552","DOI":"10.21037\/qims-21-792","article-title":"Remote vascular interventional surgery robotics: A literature review","volume":"12","author":"Zhao","year":"2022","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1177\/0278364913511350","article-title":"Robotic catheter cardiac ablation combining ultrasound guidance and force control","volume":"33","author":"Kesner","year":"2014","journal-title":"Int. J. Robot. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1109\/37.7725","article-title":"A view of automotive control systems","volume":"8","author":"Kiencke","year":"1988","journal-title":"IEEE Control Syst. Mag."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Palomino, J., Cuty, E., and Huanachin, A. (2021, January 21\u201322). Development of a CAN Bus datalogger for recording sensor data from an internal combustion ECU. Proceedings of the 2021 IEEE International Workshop of Electronics, Control, Measurement, Signals and their Application to Mechatronics (ECMSM), Liberec, Czech Republic.","DOI":"10.1109\/ECMSM51310.2021.9468837"},{"key":"ref_28","first-page":"21","article-title":"3D catheter guidance including shape sensing for endovascular navigation","volume":"Volume 11315","author":"Eixmann","year":"2020","journal-title":"Proceedings of the Medical Imaging 2020: Image-Guided Procedures, Robotic Interventions, and Modeling"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1109\/TSMC.2018.2795340","article-title":"Simultaneous input and state estimation for integrated motor-transmission systems in a controller area network environment via an adaptive unscented Kalman filter","volume":"50","author":"Jiang","year":"2018","journal-title":"IEEE Trans. Syst. Man Cybern. Syst."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"529","DOI":"10.3200\/35-09-004-RC","article-title":"Sensitivity of smoothness measures to movement duration, amplitude, and arrests","volume":"41","author":"Hogan","year":"2009","journal-title":"J. Mot. Behav."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s11548-018-1735-5","article-title":"Automated surgical skill assessment in RMIS training","volume":"13","author":"Zia","year":"2018","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kataria, V., Berte, B., Vandekerckhove, Y., Tavernier, R., and Duytschaever, M. (2017). Remote magnetic versus manual navigation for radiofrequency ablation of paroxysmal atrial fibrillation: Long-term, controlled data in a large cohort. BioMed Res. Int., 2017.","DOI":"10.1155\/2017\/6323729"}],"container-title":["Robotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-6581\/13\/5\/80\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:44:50Z","timestamp":1760107490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-6581\/13\/5\/80"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,19]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["robotics13050080"],"URL":"https:\/\/doi.org\/10.3390\/robotics13050080","relation":{},"ISSN":["2218-6581"],"issn-type":[{"value":"2218-6581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,19]]}}}