Mechatronics 64 (2019) 102295

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Mechatronics
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Review

Force sensing technologies for catheter ablation procedures ✩

V. S. N. Sitaramgupta V. a, Deepak Padmanabhan b, Prasanna Simha Mohan Rao b,
Hardik J. Pandya a,∗
a
Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore 560012, India
b
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bannerghatta Road, Bangalore, India

a r t i c l e i n f o a b s t r a c t

Keywords: Cardiac Arrhythmia, a condition of abnormal activation and conduction of electrical impulses in the heart is ob-
Minimally Invasive Surgery (MIS) served in a large proportion of the world population. Radio frequency (RF) ablation catheters have revolutionized
Catheter the treatment of cardiac arrhythmias. Over the years, researchers have been extensively working towards devel-
Cardiac Ablation
oping a more promising catheter technology that ensures definitive treatment. Since RF energy is based on the
Tactile Sensor
principle of resistive heating, to optimize effective lesion formation, a catheter to adequately sense tissue contact
Force Sensor
force becomes vital. The review focuses on state-of-the-art advancement in force sensors, design specification
and their need for interfacing with cardiac catheters. Minimally invasive medical procedures for cardiac ablation
followed by various controlling methods used for providing quality lesion have been overviewed. Several design
prototypes and variants of force sensors that can potentially be integrated with ablation catheters are reviewed
with their sensing principles and implementation.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 2
1.1. Background and motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 2
1.2. Controlling methods of energy delivery during RF ablation . . . . . . . . . . ......................................... 3
1.2.1. Impedance controlled energy delivery . . . . . . . . . . . . . . . . . . . ......................................... 3
1.2.2. Temperature monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 4
1.2.3. Contact force monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 4
2. Force sensor design considerations and its specifications . . . . . . . . . . . . . . . . . ......................................... 5
3. Configurations and transduction mechanisms used in catheters for force sensing ......................................... 5
3.1. Piezoresistive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 5
3.2. Optical technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 7
3.2.1. Light intensity modulated force sensor for cardiac catheters. . . . ......................................... 7
3.2.2. Fiber Bragg Grating (FBG) Technology . . . . . . . . . . . . . . . . . . . ......................................... 8
3.3. Other technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 9
4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 10
Declaration of Competing Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 10
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 10
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......................................... 10

✩
This paper was recommended for publication by Associate Editor Dr. Jason J. Gorman.
∗
Corresponding author.
E-mail address: hjpandya@iisc.ac.in (H.J. Pandya).

https://doi.org/10.1016/j.mechatronics.2019.102295
Received 11 February 2019; Received in revised form 24 September 2019; Accepted 27 October 2019
0957-4158/© 2019 Elsevier Ltd. All rights reserved.
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
1. Introduction
1.1. Background and motivation
Cardiac ablation is used to treat cardiac tachyarrhythmia. Abnormal
sequencing of the electrical impulses in the heart leads to arrhythmias.
Atrial fibrillation (AF) is a common type of cardiac arrhythmia where
chaotic atrial activation leads to disordered cardiac contraction. A re-
port by Chugh et al. published in 2010 shows that 33.5 million patients
were affected with AF among which 62.38% were men and 37.62% were
women [1]. The fact sheets by Centres for Disease Control and Preven-
tion (CDC), estimated 2.7 – 6.1 million people have AF and expected
further increase in these numbers [2,3]. Catheter ablation forms an in-
tegral part of the management of AF [4–6].
Cardiac ablation, a minimally invasive medical procedure, is car-
ried out using a thin, long, uni or bidirectional deflectable catheter. The
tip of the catheter contains electrode pairs which serve as a conduit to
record signals as well as a gateway to deliver energy to the tissue. The
catheter enters the cardiac chambers through the vasculature via short
or long sheaths. The tip is then placed in contact with the tissue after
manoeuvring it to the region of interest. Sequential such placements of
the catheter in different regions are used to decipher the abnormalities
in electrical signals prior to finally delivering RF energy to treat the ab-
normal rhythm. The schematic representation is shown in Fig. 1 [4–8].
Although cardiac ablation via catheters has several advantages
[8–10] compared to traditional open surgery, there are several chal-
lenges associated with its use [7,11–13]. The major challenges are accu-
rate positioning of the catheter (as the heart continues to beat through-
out the operation) with adequate contact between the cardiac wall and
the catheter tip (as the physician does not have adequate visual infor-
mation due to reduced access). Thus, utilising the catheters require a
certain level of operating skills. Hence, cardiac catheterization is per-
formed under the guidance of an experienced physician with an assistive
imaging device.
The safety and accuracy of the catheterization procedure are im-
proved with imaging techniques and force feedback. During catheter-
ization, the physician does not have a direct view of the surgical lo-
Fig. 1. Illustration of a minimally invasive medical procedure for introducing catheter into the heart via blood vessels for cardiac ablation using X-ray imaging
technique.
Mechatronics 64 (2019) 102295
cation. Hence, force feedback from the sensors and visual cues from
imaging techniques (invasive and non-invasive) can facilitate the physi-
cian to perform catheterization with better accuracy. Imaging tech-
niques are being used in preoperative and intraoperative procedures
[14–21]. Historically, fluoroscopy is the gold standard imaging modality
during catheterization procedures [14,15,22–24]. Though fluoroscopy
has an ability to image non-invasively [24] and can overlap two-
dimensional (2D) projections of three-dimensional (3D) structures for
high temporal and spatial resolution [7,16,17,21], the images retrieved
are of two-Dimensional (2D) view and are of poor soft tissue contrast
[21,22]. Additionally, it has radiation exposure to both operator and pa-
tient [7,13,21,25,26]. These restrictions have initiated exploration into
other imagining techniques to guide during cardiac procedures. Imag-
ing modalities such as computed tomography (CT) and magnetic res-
onance imaging (MRI) can also provide high-resolution images of the
heart. MRI is still in the investigational phase and requires MRI safe
catheters and materials [5,22,27,28]. This is because the strong mag-
netic field produced by MRI can induce electric current in the conduct-
ing materials and electronics and disturb its functionality [27]. How-
ever, MRI has proven safe and provides sharp images with soft tissue
contrast and without harmful radiation [5,22,27]. Conversely, CT is not
a preferred method for imaging in intravascular catheterization due to
the high radiation doses delivered to both patient and operator [29].
However, 3D computed tomography (CT) overlay technique is being in-
tegrated with the formerly obtained CT scan during fluoroscopy to cre-
ate a live 3D images of the cardiac structures [16]. Recently, Intravas-
cular Ultrasound (IVUS) [30] and Intracardiac Echocardiography (ICE)
techniques are most widely available to supplement fluoroscopy. With
IVUS, it is possible to provide excellent near-field spatial resolution,
can determine the thickness of the annular structure and subvalvular
catheter orientation, monitoring drift of the catheter and tissue inter-
face of the catheter during the ablation in real-time which are not pos-
sible with fluoroscopy. But, IVUS has limited use in electrophysiology
due to its inadequate tissue penetration and limited to a few millimeter
acoustic depth [24]. However, ICE can provide high resolution imaging
with range of 10–12 cm. ICE can also provide real-time high-resolution
cardiac structures, early recognition of thrombus formation and precise
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al. Mechatronics 64 (2019) 102295

monitoring of catheter location within the heart in a real-time with a
reduced fluoroscopy exposure [14,31,32]. In general, ICE is being used
as a complementary tool with other imaging techniques (especially with
fluoroscopy) to provide accurate catheter position and improved repre-
sentation of cardiac anatomy [33,34]. However, there are reports on
cardiac ablation procedures with the use of ICE and electroanatomic
mapping without fluoroscopy [35,36]. Currently, X-ray fluoroscopy, 3-
dimensional (3D) electroanatomical mapping systems and intracardiac
echocardiography are used for mapping [37].
Ablation catheters come with different dimensions of the tip elec-
trode. For clinical use, the 2 major subsets of catheters are irrigated and
non-irrigated; Irrigated catheters are either open irrigated or close ir-
rigated. The most common ones have a tip electrode size of 3.5–4 mm
and are 8 Fr in diameter. Larger electrode tip like 8 mm and 10 mm exist
but are used sparingly. There is an inverse relationship between the size
of the electrode tip and the spatial fidelity of mapping signals. The best
trade-offs currently are in the range of 3.5–4 mm. Additionally, the cur-
rent density is also lower with the larger tipped catheters making larger
lesions unlikely since power delivery is limited.
Catheter contact is another key parameter of lesion creation. RF en-
ergy causes tissue necrosis by the principle of resistive heating. The re-
sistance provided by the tissue to the passage of electric current between
the catheter tip and an impedance patch placed on the back of the pa-
tient creates heat energy which results in tissue necrosis. Irrigation cools
down the tip of the catheter and thus prevents the formation of coagu-
lum on the tip. In addition, it enhances the power delivered to the tissue
by increasing the temperature difference between the catheter tip and
the tissue. Anatomic factors like nearby blood vessels as well as endocar-
dial pouches and scar tissue created by surgery can additionally affect
the formation of lesions. Therefore, one of the key modifiable compo-
nents irrespective of whether the catheter is irrigated or not remains
tissue contact.
1.2. Controlling methods of energy delivery during RF ablation
The goal of the ablation is to create a quality lesion. Increasing the
size and depth of an ablative lesion cannot be considered as ablation
success if the selected site for ablation is poor. RF lesions can be formed
by providing energy to the tissues. However, an excess amount of energy
delivery leads to further complications. For example, to create a tissue
necrosis temperature higher than 50 °C is enough. At the same time,
when the tissue temperature exceeds 100 °C, it leads to denaturation of
proteins due to the boiling of plasma and causes steam pop. This results
in electrically insulating coagulum at the electrode tip. Further, it is no-
ticed as a swift response in electrical impedance and prevents the heat-
ing of tissue. Therefore, careful monitoring of certain parameters, alone
and in combination, is important to achieve successful and safe ablation.
Commonly used parameters include impedance monitoring, electrode-
tip temperature monitoring, and catheter-tip contract force monitoring
[23,38–42].
1.2.1. Impedance controlled energy delivery
Electrode tip temperature monitoring alone is found to be less reli-
able due to convective cooling of catheter tip by the bloodstream. Thus,
the transfer of thermal energy to the deeper layers of the tissue cannot
be achieved [23,40]. The schematic representing different zones of heat
transfer mechanisms such as resistive, convective and conductive from
the catheter during RF ablation is shown in Fig. 2(a). The catheter tip
temperature measured using the temperature sensor indicates approxi-
mated tissue temperature [23,40,42]. Thus, monitoring the gradual drop

Fig. 2. Schematics of cardiac ablation catheters, equivalent electrical circuits and optical photograph: (a) Demonstrating the zonal heat transfer from a catheter
during ablation of endocardial tissue, (b) The equivalent impedance of ablation system during energy delivery (c) Actual power delivered to the tissue during the
ablation with 4 mm tip (left) and 8 mm tip (right) catheters, (d) Irrigated electrode catheters: the closed-loop catheter (left) and the open-irrigation catheter (right),
(e) St. Jude Therapy Cool Flex: TherapyTM Cool FlexTM ablation catheter with irrigation [46].
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
in impedance is a useful indicator for tissue heating. The RF electrical
current flowing through the tissues establishes a correlation between
heating and impedance. Moreover, the magnitude of the current at the
tip of the catheter is proportional to the impedance offered by differ-
ent components of the system. Typically, the impedances are offered by
RF generator, transmission lines, tissue (165 Ω), catheter tip (varies with
tip dimensions and material), blood pool (varies with electrode position,
orientation and contact area) and the dispersive electrode (45 Ω). The
ablation system equivalent circuit is shown in Fig. 2(b). The literature
shows that most of the electrical power is absorbed by the blood, body
and dispersive electrode through electrical conduction. Hence, limited
power is delivered to the tissue. The dimensions of the electrode gov-
ern the amount of power delivered to the tissue. It has been estimated
that 9% - 10% of the total power being delivered to the tissue out of
50 W of power given to the catheter [23,40,42] is delivered to the tis-
sue. Fig. 2(c) shows the power delivered to the tissue with a 4-mm (left)
and 8-mm electrode (right) tip on applying a power of 50 W power to the
catheter during ablation. In addition, the larger electrode offers lower
blood pool resistance when compared with smaller tip electrodes be-
cause of the greater surface area. The typical impedance between tissue
and catheter is 90 Ω to 120 Ω (before heating) [40].
The correlation between impedance and temperature is investigated
by observing the impedance drop. Impedance drop can be due to poor
catheter contact with the tissue as well as low blood flow rates [40].
It has been reported that 5 Ω to 10 Ω reduction in impedance can be
correlated to a tissue temperature of 55 °C to 60 °C in the absence of
irrigation; this impedance reduction can be observed because of tissue
heating which forms tissue necrosis [23,40]. Due to tissue necrosis, in-
tracellular water forms the interface instead of healthy tissue which has
a lower impedance than intact tissue. In presence of adequate contact,
in a non-irrigated catheter, the rise in impedance may herald the earli-
est sign of coagulum formation. Coagulum, a viscous gel consisting of
denatured blood proteins, has higher impedance than tissue. In certain
cases, it is critical to recognise and may cause the catheter to adhere to
tissue and restricts the further movement of the catheter. Coagulum, if
embolised, can also cause distal vessel occlusion namely pulmonary or
systemic embolism.
1.2.2. Temperature monitoring
Application of high ablation temperature can increase lesion size, but
it would result in the formation of coagulum and increase in impedance
[23]. Proper control of temperature during ablation, can avoid exces-
sive heating and leads to less formation of coagulum. Hence, the abla-
tion temperature is limited to a range of 60 °C to 70 °C for non-irrigated
catheters. Consequently, the temperature of the electrode tip is cooled
down by the surrounding blood thereby enhancing power and thereby
heat transfer. This phenomenon is greater an electrode with high ther-
mal conductivity material such as gold [6,23,42]. Due to excessive heat
loss at different regions as shown in Fig. 2(a), temperature measured
with the sensor, using thermistor or thermocouple within the catheter,
does not represent tissue temperature. [40,42]. Moreover, for high blood
flow area or with irrigation, the difference in tip temperature and tem-
perature of the tissue is higher. Hence, for safety, the temperature con-
trol ablation is not very accurate [40].
Ablation in low blood flow areas with non-irrigated catheters creates
poor lesions since the heat transfer is impaired owing to poor cooling
effect at that location. However, studies show that active cooling of the
electrode tip can be used to improve energy transfer. Cooling of the tip
can deliver higher power to the tissue without a swift response in elec-
trical impedance. This can be accomplished by infusing saline (0.9%) at
room temperature through the ablation catheter in an open irrigation
design at a rate of 10 to 60 ml/min during RF delivery and 2 ml/min
during the remaining times [23,40,42,43]. It has also been reported
that with an irrigated-tip catheter, a higher lesion depth of 9.9 mm is
observed when compared to 6.1 mm depth formed with temperature-
feedback power control delivery with non-irrigation catheter [44].
Mechatronics 64 (2019) 102295
Active tip cooling can be achieved with either a closed irrigation tip
or open perfused-tip system. Four different active cooled methods are
available [23], but mostly either open system irrigation or closed system
irrigation are used as shown in Fig. 2(d). In both cases, saline will be in-
fused through a pump to cool the electrode tip. An open irrigated system
infuses the saline into the blood through the holes at the tip, whereas
a closed irrigation system recirculates the saline as shown in Fig. 2(d).
Closed irrigation catheters fell out of favour owing to the risk of steam
pops which were higher, thereby leading to open irrigation techniques
as the current preferred mode. Tissue temperature is an important pa-
rameter during ablation for deciding the power delivery. In the absence
of temperature monitoring as a feedback mechanism, the surgeons de-
pend on surrogates (such as impedance, power and contact force) which
have their limitations.
Recent developments show different catheter-tip designs for cool-
ing the tip. Standard irrigation channels are either 6 or 12 which are
arranged circumferentially at the distal end [23,45]. Amongst the com-
mercially available catheters such as Biosense Webster ThermoCool SF
ablation catheter, Biosense Webster Thermocool Smarttouch, and Ther-
apy Cool Path St. Jude 7-F 4-mm-tip ablation catheter, the St. Jude
TherapyTM Cool FlexTM ablation catheter shown in Fig. 2(e) has a better
tip design facilitating flexibility with an optimal irrigation as compared
to other catheters. The flexible tip is of 4-mm and it is designed to adapt
the shape of the tissue with better contact, thereby increasing the tip-
tissue interface. The tip has four irrigation ports and the electrode is
laser cut in a zig-zag pattern which allows flexibility and uniform irri-
gation [23,45,46].
1.2.3. Contact force monitoring
Although monitoring and controlling the temperature during the RF
ablation minimizes the impedance rise and formation of coagulum, but
the lesion size is limited by the input power applied, as discussed in
Section 1.2.2. With good tissue contact, the required temperature can
be achieved with low power [23,40]. Contact force sensing by giving
feedback on the same can improve power delivery. The significance and
role of catheter-tissue contact force sensing mechanism are discussed in
the sections below.
Impact of Contact Force Sensing
During ablation, the quality and the efficiency of the ablation de-
pends on, contact between the catheter tip and the tissue. Recent stud-
ies indicate that the contact force is an important factor for determining
the quality of ablation or lesion formation [7,23,38,40,47–52]. With a
good electrode-tissue contact, more energy is coupled/delivered to the
tissue. In addition, information about the force applied to the tissue will
improve the accuracy of the surgery. This is because low contact force
results in ineffective lesion formation and does not resolve arrhythmias
due to insufficient ablation. Conversely, higher force effects ablation vol-
ume and can cause injury to the tissue and increases the risk of steam
pop and cardiac perforation [7,23,38,40,47–52]. Hence, several types
of force sensors are being used and interfaced with cardiac catheters.
Contact force sensing has several advantages: Firstly, it provides
force feedback during mapping and ablation to ensure safety. Secondly,
force sensors have higher bandwidth compared to image assisted de-
vices. Thirdly, the mechanical contact between the cardiac wall and the
catheter tip can increase the quality of ablation. Lastly, it can restore
the surgeon’s perceptual capability by providing haptic feedback when
operating using robots. At present, force sensing catheters are unable to
provide haptic feedback. Current sense of haptic feedback is based on
the operator’s sensitivity and experience. This is a costly skill to have and
is achieved after several mishaps, if at all. Similar limitations are faced
by surgeons operating with robotic assistance devices without haptic
feedback [5,10,27].
Several types of force and tactile sensors are currently being devel-
oped, actualized and interfaced with cardiac catheters. The developed
sensors are implemented using different modes of transduction methods
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al. Mechatronics 64 (2019) 102295

such as piezoresistive [10,13,52,61–63,66–71], piezoelectric [10,72–

Minimally Invasive Surgery

75], fibre-optic [5,7,10,25,26,38,49,54,56,76–78], magnetic [60]. Con-

Minimally invasive robotic

laparoscopic operations

laparoscopic Surgery tool

Hand grasping activities

Cardiology mitral valve

Cardiology mitral valve

tissue palpation during

versely, other transductions method such as capacitive based force sens-

Cardiac catheterization

Cardiac catheterization

Cardiac catheterization

Cardiac catheterization
ing [79–83] can have good sensitivity and resolution. However, the first

Fetal surgery tool

Balloon Catheters
stage of signal conditioning circuit should be very close to the sensor

Cardiac ablation
Cardiac ablation

Cardiac ablation
Cardiac ablation
annuloplasty

annuloplasty
which makes the system bulky [52].

Application

Guidewire
There are very few sensors available for measuring both normal and

surgery

General
shear forces acting on the tip of the catheter. A substantial amount of
study has been conducted and summarized on different force sensing
techniques in minimally invasive surgeries (MIS) [8], force and tactile

0.38×0.38×0.01

0.42×0.42×0.07
sensors for MIS [10,72,84], an MRI compatible fiber-optic based force

2.3 × 2.3 × 1.33

D: 2.2; L: 0.2
D: 5.5; L: 12

1.9 × 1.9 × 50
D:4; H:24.5

D: 4; H: 10
and tactile sensors for MIS [5,27]. Table 1 shows the force sensors de-

D: 3; L:18

2 × 2 × 0.3
Size (mm)
veloped by several groups that can potentially be integrated into the

4×4×4
D: 3.5
D: 3.5
D: 10

1×1
catheter. The force sensor operating principle, sensing range, resolution,

D: 6

D: 5

D: 3

D: 4
the degree of freedom (DOF), compatibility, dimension, and applications
are also summarized. This article provides a detailed review of force and
tactile sensors exclusively for catheter applications.

NA (Possible with X-ray)

Possible with X-ray and
Possible with MRI

Possible with MRI

Possible with X-ray

Possible with X-ray
Possible with X-ray
Possible with X-ray

Possible with X-ray

3D ultrasound and

3D ultrasound and
2. Force sensor design considerations and its specifications

Compatible
Compatibility
Summary of the force sensors that are compatible with cardiac catheters with no modifications or minimum modifications. (D – Diameter; L – Length)
In order to integrate the sensor in the ablation catheter, the sensor
size is limited to the diameter of the catheter [5,61,69,85]. However,

MRI

X-ray
MRI

MRI

MRI
MRI
MRI

MRI

MRI
MRI
the diameter and the thickness of the sensor depends on the desired

–
characteristics. Conversely, the sensor should be highly sensitive with a
good resolution. Though 0.2 N – 0.3 N is targeted and considered as a
good contact between the tissue and the catheter tip, the working range DOF (Degree of Freedom)
of the sensor should be in the range of 0 – 0.5 N with a resolution of 1 g
[5,7,26,86]. The specifications of the catheter tip force sensor are listed

Shear Force
in Table 2. In addition, the sensor should be made of biocompatible

Three axes
Three-axis

Three-axis

Three-axis
Three-axis
Three-axis
Uni-axial

Tri-axial
Tri-axial
Tri-axial
Tri-axial
Uniaxial

materials and should be suitable for sterilization procedures [5]. Uniaxial

Triaxial
Tactile

Tactile

Tactile
In fact, the measurable range of the sensor should be higher than

8°
the working range, to protect the sensor from overloading. Moreover,
the measurement should be accurate with enough sampling frequency.
The human heart has a dynamic environment with a normal beating

Lateral:4 mN
rate around 60 - 100 times per minute. Hence, the typical operating
Linear:8 mN;
bandwidth of the sensor should be at least 2 Hz [25,54].
Resolution

< 0.01 N
< 0.01 N

Another major constraint includes the size and cost of the sen-
0.13 N

0.04 N

0.04 N

0.02 N

0.01 N
0.2 N

0.1 N
sor. Many research groups have investigated and developed various
–

–
–
–
–
–

–
force and tactile sensors that can be integrated with the ablation
catheter. However, the use of these sensors is not limited to ablation
Axial:0.85 N; lateral:0.45 N

Gripping: 1 - 20 N Tactile:

Normal: 23.6 mN; Shear:

Axial: 2.5 N; Radial:1.7 N

catheters but can actively be used in other medical applications as well

Axial:3 N; lateral:1.5 N

[65,69,71,80,87–95].

3. Configurations and transduction mechanisms used in catheters

0.01 −2 N
Force Range

4.71 mN
for force sensing
0–0.85 N
0 - 0.2 N

0 - 0.5 N

0 - 0.4 N

0-3N
0–1.1N

20 mN
0–4 N

1.5 N
0.5 N
0.4 N
10 N

2N

The basic concepts of transduction mechanisms that are used in the

–

catheters are discussed in this section.

Fiber-optic Pressure sensor

3.1. Piezoresistive
Piezoresistor (SiNWs)
Intensity modulation

Intensity modulation

Intensity modulation
Intensity modulation
Intensity modulation

Intensity modulation

Intensity modulation

The most commonly used technology for sensing the force involves
Piezoresistive

Piezoresistive
piezoresistor
Strain Gauge
Piezoresistor
Piezoresistor

measuring the deformations of the structure using strain gauges or

Magnetic
Intensity
Principle

piezoresistors [55]. Piezoresistive force sensors can be miniaturized us-

Optical

ing a microfabrication process. Thus, a small size, low thickness, quick

FBG

response, linear, and highly sensitive sensor with better resolution out-
put can be achieved [73]. On application of force to the piezoresistive
Thanh-Vinh N et al., [62]
et al., [26]

et al., [58]
et al., [7]

Puangmali P et al., [59]

sensor, the structure deforms and subjected to stress; and the stress in-
al., [57]

Yokoyama et al., [38]

nakagawa et al., [60]
Kesner sB et al., [55]
Tohyama et al., [53]

duced in the structure results in a proportional change in the resistance

Beccai L et al., [61]
Noh Y et al., [25]

Wang L et al., [65]

Pandya et al., [52]

Radó J et al., [63]

Peirs J et al., [56]

Han B et al., [13]

of the sensor. The change in resistance can be converted into electronic

Hu Y et al., [64]
Yip et al., [54]

Polygerinos et
Polygerinos, P
Polygerinos, P
Polygerinos, P

signals using signal conditioning circuits. Furthermore, the use of spe-

cial structural elements and multiple piezoresistive elements at differ-
Authors
Table 1

ent locations can allow multi-axis force measurements [8]. The details
of different piezoresistive force sensors used in biomedical applications
are given in [8,10,13,27,62,72,73,84,96].
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al. Mechatronics 64 (2019) 102295

Fig. 3. Piezoresistive based force sensors: (a) Tactile Sensing chip with mesa structure and carrier chip for connections [61], (b) Schematic view of PDMS tactile
sensor with three types of microstructures using PDMS caps and cantilevers [62] (c) Schematic view of sensing mechanisms of PDMS tactile sensor under different
loading [62], (d) Atri-axial force sensor made of PEDOT: PSS strain gauge and PDMS bump interfaced at the tip of catheter [52], (e) A hybrid piezoresistive- optical
tactile sensor [66], (f) A tri-axial ring-shaped force sensor integrated with guide wires and inserts shows the attachment of force sensor to the guide wire and the
location of silicon-nano wire piezoresistors [13], and (g) A piezoresistive based force sensor integrated to a laparoscopic surgery tool for measuring gripping force
and tactile sensing [63].
((a), (b), (c) “© Elsevier Publishing. Reproduced with permission. All rights reserved”, (d) “© IEEE Publishing. Reproduced with permission. All rights reserved”, (e)
“© SPIE Digital Publishing. Reproduced with permission. All rights reserved” and (f) “© Springer Publishing. Reproduced with permission. All rights reserved”).

Table 2 the force applied at the tip of the post develops the stress on the di-
Catheter-Tip force sensor specifications [5,7,25,26] aphragm resulting in a change of resistance in four piezoresistors. The
Characteristics Specifications magnitude of resistances depends on the position of forces at the tip and
is collected at the carrier chip. To increase the sensitivity, a mesa struc-
Sensor Size 6–15 Fr (2 −5 mm)
ture has been integrated with the diaphragm at the centre as shown in
Safe ablation Force 0.2 – 0.3 N (20 −30 g)
Working Range 0 – 0.8 N (0 – 80 g) Fig 3(a). The sensor can quantify both normal and shear forces up to 2 N
Measurable Force 0 – 1.5 N (0 – 150 g) with a linearity of ~99%. The same group embedded the triaxial force
Resolution ≤ 0.01 N (1 g) in the fetal surgery tool and validated the feasibility of mounting the
Bandwidth 2 Hz
sensor on this cutting tool [69,71]. Later, similar structures have been
Linearity 95%
Hysteresis As low as possible (~10%)
reported for the detection of 3 D forces in the range of few millinewton
(mN) [64,75,98–102].
Thanh-Vinh N et al. [62] developed a PDMS and silicon technology-
based tri-axial tactile sensor with increased sensing area and sensitivity.
Piezoresistors have been widely incorporated for tactile sensing It uses PDMS cap to transfer the force to the cantilevers, which change
mechanism [68,97], however, the sensor is designed for low force (< the resistance of the piezoresistors connected to it. Three different con-
1 N) applications and cannot be used for ablation. Fig. 3(a) shows a tri- vex microstructures such as pyramid-shaped, pillar-shaped and a ring-
axial force sensor reported by Beccai L et al. [61]. The sensor contains shaped PDMS caps are designed as shown in Fig. 3(b) and compared
four piezoresistors mounted on the surface of the diaphragm such that their sensitivities under normal and shear loads shown in Fig. 3(c). It has
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
been reported that the pyramid-shaped microstructures have the highest
sensitivity to normal force and the ring-shaped structure have good re-
sponse with a shear force. However, the sensor has not been integrated
with the cardiac ablation catheters. The proposed design containing air
cavity is compared with the conventional design i.e. embedded inside
an elastic body showed an increase in sensitivity by approximately 100
−150 times in both shear and normal forces [62,72]. Similarly, Pandya
et al. [52] developed a PDMS based real-time 3-D catheter contact force
sensor using a strain gauge. The developed tri-axial force sensor has five
flexible strain gauges made of PEDOT: PSS material and PDMS bump,
placed on a plastic cubic bead as shown in Fig. 3(d). Additionally, the
developed force sensor has been evaluated by integrating to the tip of
the commercial catheter (Coloplast SpeediCath®). The results showed a
good response and linearity to the measurable force of catheters. How-
ever, the sensor has not been integrated and tested with the ablation
catheters.
A hybrid tactile sensor for sensing the tissue stiffness and corre-
spondingly detecting tumour has been developed by Bandari, N.M. et al.
[66] using piezoresistive-optical-fiber technology. The stiffness of the
tissue is detected by using piezoresistive force sensing elements and two
optical fibers connected on the deflection structure. The deflection of the
beam develops an angular misalignment between fibers, which leads to
power loss between fibers as shown in Fig. 3(e). However, the proposed
design cannot be used directly for the measurement of distal forces on
the tip of catheters. This is due to the dimensional constraint for inte-
grating with the cardiac catheters.
A piezoresistive transduction-based tri-axial force sensor integrated
on the distal tip of guidewire is reported by Han B et al. [13]. The use of
SiNWs (silicon Nanowires, shown in the insets) provides an advantage of
detecting nanometre range displacement with high sensitivity, accuracy,
and linearity along with a reduction in size. In addition, the structure
minimizes bending artefacts as reported in [13]. The ring shape sensor
structure can easily be integrated with the movable core guidewires for
the measurement of distal tip forces. The limitation is that it cannot be
directly integrated with the ablation catheters for measurement of forces
on the tip. This is due to the geometrical constraints of the catheters and
the operational range, and dimensions of the sensor.
More recently, a piezoresistive type force sensor has been developed
by Radó J et al. [63] integrated to a laparoscopic surgery tool tip for
providing additional tactile and force feedback to the surgeon. The sys-
tem is integrated with two sensors, one for measuring gripping force
(force range 1- 20 N) and another for tactile sensing (force range 10 –
2000 mN) as shown in Fig 3(f). In fact, these sensor designs are sim-
ilar to each other; with the only difference being in their geometries
(especially thickness). Furthermore, these sensors provide information
on the surface roughness and the hardness of the tissue. The sensor
Fig. 4. Intensity modulated fiber optic transductions: (a) Reflective type (b) Transmittive type, and (c) Multi-axial force sensing catheter utilising reflective type
transduction principle using 3 optical fibers (“© Elsevier Publishing. Reproduced with permission. All rights reserved”) [56].
Mechatronics 64 (2019) 102295
uses a biocompatible elastic polymer such as PDMS to cover the sen-
sor. Though it affects sensitivity and response of the signal, it protects
the circuit and patients from the environment and infection. Similarly,
the required flexible electronics to measure, condition and process the
output of the sensor has been discussed [70]. Although, the working
range of the tactile sensor is compatible with the operating range of the
ablation catheter force sensors, the mounting of this sensor for interfac-
ing with the ablation catheters has not been tested.
The use of piezoresistive type sensors in cardiac ablation catheters
is limited to X-ray imaging techniques as these sensors are not MRI-
compatible. This is because conductive wires act as MR-antennas inside
an MRI scanner and causes heating effects on the conductive wire. More-
over, it can distort the MR images and generate health risks [5,7,26,27].
3.2. Optical technology
Optical force sensing is the most commonly preferred technology
in cardiac catheterization. Small size, light weight, and insensitivity
to electromagnetic interference make optical force sensing suitable for
use in cardiac catheter applications [27,59]. Moreover, most of these
sensors are compatible with the MRI environment. Amongst fiber op-
tic transduction mechanisms, the light intensity modulation and Fiber
Bragg Grating (FBG) technology are most commonly used for catheter
contact force measurement [8,21]. While interferometry detection is sel-
dom used [72]. This section gives a detailed overview of optical force
sensors that can be interfaced with cardiac ablation catheters.
3.2.1. Light intensity modulated force sensor for cardiac catheters
Light intensity modulation is the most commonly preferred optical
force sensing modality in cardiac catheterization. This is due to the in-
sensitivity of sensor output to either the temperature or electromagnetic
field or radio frequency power used for heart ablation [25]. Moreover,
it is simple, inexpensive and readily adapted method for several geome-
tries. This configuration typically uses a minimum of a single pair of
straight transmitting and receiving optical fiber, such that the output
is a measure of displacement. This is because the force acting on the
catheter tip causes the mirror surface to shift relative to the input force.
This leads to a change in the reflected light intensity that is transmit-
ted from an emitter optical fiber. In the c reflective measurement, the
intensity of the reflected light is affected by the distance between the op-
tical fiber and the mirror surface [54]. In transmissive-based intensity
measurement, a shift in the focus location is due to the translational
displacement of encoder lens [77]. Fig. 4(a) and Fig. 4(b) show the re-
flective and transmissive type light measurements [78].
Yip et al. [54] designed a simple, robust, and miniature uniaxial force
sensor for measurement of tissue interactive forces during mitral valve
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
Fig. 5. Signal quality improvement illustrations: (a) Illustration of force sensor utilizing a bent tip reference pair and (b) Illustration of system utilising coupler for
fiber misalignments (“© Elsevier Publishing. Reproduced with permission. All rights reserved”) [56].
annuloplasty within a beating heart. The force sensor constitutes of a
single pair optical fiber for transmitting and receiving of light that is re-
flected from the reflector placed on the elastomer element. It has been
reported that the use of the elastomer element can enhance robustness,
electrical passivity and waterproof seal with a room for instrumentation.
Besides single pair, the use of three pairs of an optical fiber placed in
the triangular formation can reduce the sensitivity of the reflective plate
rotation, from off-axis loads or uneven tissue contact [54]. Conversely,
Kesner SB et al. [55] designed and fabricated a low cost, customizable
uniaxial force sensor using the rapid prototyping technology, for the tip
of a robotic catheter system. The 3-D printed force sensor uses a flexure
design which can provide, large axial deflections and connected with a
mirror at the bottom of the flexure. The use of fiber optic technology
can measure the flexure deflection by determining the intensity of the
reflected light. Additionally, the developed force sensor can be easily
accommodated for MRI measurements; and it can be used to measure a
force range of 10 N with an accuracy error as low as 2% [55]. The multi-
axis force sensor shown in the Fig. 4(c) has been developed by Peirs J
et al. uses three optical fibers for minimally invasive robotic surgery
applications [56]. The optical fibers are arranged at 120° intervals such
that, when an axial force is applied, all the optical fibers detect the same
displacement change while radial forces experience different displace-
ment changes. The authors reported a resolution of 0.04 N with a force
range of 2.5 N and 1.7 N in the axial and radial direction.
Although use of single pair optical fiber is the simplest configura-
tion and can have great potential for sensing displacement, this con-
figuration can also be inherently inaccurate". The effect of small fiber
bending or light intensity degradation over time can degrade the sen-
sor quality. This can be compensated with the use of secondary optical
fiber as reference fiber [5,7,10,27]. The simplest illustration is projected
by Puangmali et al. to overcome the light losses due to the bent tip as
shown in Fig. 5(a) [59]. The same group has also published a mathe-
matical model supporting the intensity-modulated bent-tip optical fiber
with a planar reflector designs for the measurement of displacements
[76]. Peirs J et al. used a coupler shown in Fig. 5(b) to transmit and re-
ceive light to a single fiber such that the signal distortions which often
come with misalignment of the fibers can be eliminated [56].
Polygerinos et al. [7] developed a customised cardiac catheter inte-
grating a reference fiber and a coupler. A method implemented in the
cardiac catheter for compensating the losses due to fiber bending, trans-
mission, and fiber misalignments. The proposed cardiac catheter is MRI
compatible and can detect the interaction forces with the cardiac walls.
The catheter consists of a catheter-tip guide, elastic material, and a re-
flector guide such that application of axial force on the tip, deforms the
elastic material. This leads to a change in the distance between optical
fiber and the reflector. The reflected light intensity corresponding to the
catheter-tip force is an indication of the normal force acting on the tip
alone.
Mechatronics 64 (2019) 102295
Besides the single axis, a tri-axial force sensor is also developed by
Polygerinos, P et al. [26] by slightly modifying the elastic material dis-
cussed in [7]. The proposed catheter is used for detection of applied
force on the cardiac tissues during the cardiac ablation procedures. The
developed catheter uses seven plastic interconnects made by using rapid
manufacturing techniques to decrease the fabrication cost and for MRI-
compatibility. The sensor consists of an arrangement of force sensitive
structure (also called as flexure), optical glass fiber cables and the plastic
reflector. The flexure design uses a hollow cylinder with three symmet-
rical horizontal beams arranged uniformly in a circular fashion for the
detection of both normal and axial forces acting on the tip. These forces
translate the reflector away from its origin, thereby either decreasing
or increasing the distance between each optical fiber and reflector. A
fiber alignment module is used to align the position of optical cables.
The characterising results obtained during the calibration of the sensor
confirm that the developed catheter can measure the axial force up to
0.5 N and lateral to 0.45 N with a resolution of less than 0.01 N [26]. The
performance of this sensor for the measurement of force during ablation
has not been explored.
Puangmali P et al. [59] designed a miniature 3-axis distal force sen-
sor that is compatible with laparoscopic operations for performing tissue
palpation and measurement of interaction forces at the tip. The sensor
employs a reference and sensing fiber pairs for accurately identifying
the localized tissue lesions or hard lumps buried under an organ’s sur-
face. The sensor assemblies contain flexible tripod structure, a movable
reflector along with the three pairs of sensing optical fibers. Peirs J et al.
[56] incorporated a flexible structure made of strong, biocompatible ma-
terial using titanium alloy and mounted on a surgical instrument shaft.
Although, the working range of these sensors are suitable to measure
the forces required during ablation, further investigation is required for
mounting them.
Noh Y et al. [25] developed a simple, miniaturized, robust three-
axis force sensor integrated with cardiac catheters, with use of three
cantilever beams in the 3 D printed deformable mechanical structure
as flexures. In this system, the force between the tip of the catheter and
the cardiac tissue is obtained by using a digital USB camera and measur-
ing the reflected light intensity from the optical fiber. The noise signals
are reduced by applying a Kalman filter. The calibration performed on
the fabricated system showed a linear output and can measure an axial
force up to 1.5 N. Though the use of MRI compatible materials and the
design of flexures allow it to use for three-axis force sensing, the use of
acrylic material at the tip cannot provide ablation for the treatment of
arrhythmias.
3.2.2. Fiber Bragg Grating (FBG) Technology
By the virtue of miniaturisation of the sensor, FBG technology pro-
vides a good sensitivity with a better resolution compared to the light-
intensity modulated technology. However, the complexity and the need
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
of expensive phase masks surge the cost of sensing system compared to
light intensity modulation [25,103]. Furthermore, it has limited band-
width and cross-sensitivity to the temperature which leads to errors in
the strain measurement. Hence, it is required to compensate for temper-
ature changes for accurate measurement of strain [25,103]. In addition,
the use of optical source and spectral analysis equipment increases the
overall cost of the system [25,27,103,104]. Lastly, for the strains smaller
than 100 μɛ, these sensors pose challenges with practical implementa-
tion [25,103].
In general, FBG technology has gratings inscribed in the optical fiber
to enhance the strain measurements. These gratings shift the Bragg
wavelength of the output light due to change in periodicity and the
effective index [72,103]. The mechanism behind it is the application
of forces on the FBG would change both refractive index and the grat-
ing intervals. Thus, FBG technology and the analysis of reflected light
spectrum is used as a tactile sensor and tactile perception for minimally
invasive surgery as proposed by Ledermann et al. [104].
A novel, commercially available cardiac catheter (TactiCath Quartz
ablation catheter) developed by Endosense SA (now owned by St. Jude
Medical Inc., USA) uses FBG fibreoptic cables for detection of both force
and the contact angle. TactiCath is a 7 Fr (3.5 mm) quadripolar ablation
open irrigation catheter containing thermocouple at the tip and six small
irrigation channels around the circumference as shown in Fig. 6(a). It is
used to provide physicians with real-time measurement of the contact
force between the catheter tip and the cardiac tissue while performing
ablation procedure for the treatment of atrial fibrillation (AF). The force
measured by monitoring the wavelength of the reflected light, due to the
change in fibre Bragg Gratings (FBG), can be used to estimate the mag-
nitude and the angle of contact force [38]. Although, the working range
and the size is within the range of ideal specifications as listed in Table 2,
the sensor resolution and the hysteresis require further improvement.
3.3. Other technologies
Wang H et al. [6] invented an open irrigated ablation catheter to
determine tissue contact with the catheter by measuring the pressure
inside the lumen of the catheter using a pressure sensor. The manifold
connected to the distal end of the ablation electrode contains different
outlets to exit fluid (in this case saline) out of the catheter. When the
catheter is in contact with the tissue some plurality of openings or saline
Mechatronics 64 (2019) 102295
Fig. 6. Commercially available contact force
catheters: (a) FBG based sensor for cardiac ab-
lation [38] and (b) Non-optical contact Force
sensing ablation catheter [60].
((a) and (b) “©Ahajournals Publishing. Repro-
duced with permission. All rights reserved”).
outlets will be blocked by the tissue, which results in an increase of pres-
sure inside the electrode. In general, the pressure inside the electrode
is a function of blockage of openings, provided the saline flow rate is
constant. In addition, a lot of research is focused on detection of forces
using tele-operated robotic catheter system without the need of distal
force sensors. Moreover, it can also provide haptic feedback to the sur-
geons. These systems use motors and controllers to measure the forces
indirectly by measuring the current drawn by the robot actuators while
driving a surgical tool or catheter at the distal end. However, calibration
and compensation techniques are required for accurate measurement of
forces acting, without any friction and backlash [105–107].
Another popular catheter, ThermoCool ablation catheter (Biosense
Webster, Diamond Bar, CA) is a 3.5 mm (7 French) tip open-irrigation
ablation catheter as shown in Fig. 6(b). This is commercially available
real-time contact force cardiac ablation catheter which uses a magnetic
transmitter for detection of contact force [23,42,48,108]. Internally, the
electrode-tip is mounted on a precision spring and connected to the
catheter shaft, with a magnetic transmitter coil and sensors between
them. The magnetic transmitter is used as a reference location signal and
the sensors measure the micro-deflections of the spring. Thus, precise
tracking of the catheter tip is achieved. It is reported that the catheter
tip contact force and the direction can be measured with a resolution
of 1 g for every 50 ms. For better accuracy, the catheter should be cali-
brated to the body temperature within the blood pool for at least 15 min.
Additionally, the degree of spring bending can also be detected using the
transmitter and the sensor [23,27,42,48,60,108].
Besides the contact force measurement, different mechanisms have
been developed for aiding the surgeons during the driving of catheters
in minimally invasive surgical procedures [74,109]. Esashi M. et al.
[109] fabricated a miniaturised side wall pressure sensor and a piezo-
electric based catheter tip for the study of urodynamics. Wang H et al.
[74] developed a tactile sensor based on polyvinylidene fluoride (PVDF)
material that can be wrapped on the catheter tube for the detection of
pressure on the catheter side wall for intravascular neurosurgery. The
advantage of this technology is that the surgeon can feel the forces ap-
plied on the side wall of the blood vessels and the catheter while op-
erating. The sensor is approximately 2.5 mm in diameter with a length
of 20 mm insulated with a rubber film to make it suitable for insertion
into the blood vessels. The sensor interfaced with the developed signal
conditioning circuit could measure a maximum force of 300 mN, which
V. S. N.S. V., D. Padmanabhan and P.S.M. Rao et al.
is suitable for practical applications. A force feedback mechanism for
neuroendoscopist to provide pressure feedback during endoscopy has
been recently developed by Codd, P.J et al. [110].
4. Conclusion
In cardiac ablation procedures, the contact force between the car-
diac tissue and the catheter tip is significant for a good quality ablation.
This is clear from the procedural details discussed and the tediousness
of the current process. A small error in the contact force measurement
can result in several complications such as inefficient and insufficient
ablation; also, it can have high chances of recurrence. Conversely, the
higher force could cause injury to the tissue, with a high risk of steam
pop and cardiac perforation. These complications can be obviated if con-
tact force is measured with higher accuracy. The ability to measure force
while the catheter is guided into its target location during the treat-
ment is also crucial. Thus, it is clear that force sensing is required at all
steps from catheter entry, reaching the targeted area, ablation and then
retrieval. The main aspect is the site measurement. For this purpose,
piezoresistive, optical, piezoelectric, and magnetic methods have been
used. The advantages and shortcomings of these methods have been dis-
cussed. The forces acting on the catheter while it is guided are studied
in detail by incorporating the pressure sensor at the side wall of the
catheters and by measuring the current drawn by the robot actuators.
There are substantial avenues for improvement and innovation in this
niche area. Integrating haptic feedback, tactile sensor (for precise detec-
tion of a wide range of local force), accurate prediction of steam pops,
and assessing transmurality can potentially result in a smart catheter for
ablation procedures.
Declaration of Competing Interest
We wish to confirm that there are no known conflicts of interest as-
sociated with this publication and there has been no significant financial
support for this work that could have influenced its outcome.
Acknowledgement
The authors acknowledge the contribution of Gurrala Rohith,
Prakhar Verma, Maitreya Rana and Bhushan V. to this review. The au-
thors also extend their gratitude to Mansi Saxena and Alekya B. for pro-
viding insightful feedback during article preparation. Hardik J. Pandya
acknowledges Indian Institute of Science, Bangalore for the start-up
grant to establish the research and computational facilities at the De-
partment of Electronic Systems Engineering.
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Mechatronics 64 (2019) 102295
Sitaramgupta pursued his under-graduation in Electronics In-
strumentation and Control Engineering at NBKR Institute of
Science and Technology, India. He was awarded Dual Mas-
ter’s degree from VIT University, Vellore and University of
Applied Sciences Karlsruhe (HsKA), Germany. He worked as a
Student Research Assistant at KIT University and Fraunhofer-
IOSB, Germany and then joined as a Research Associate at M.S.
Ramaiah School of Advanced Studies. Later, he worked as an
Assistant Professor at M.S.Ramaiah University of Applied Sci-
ences. He is currently pursuing his Ph.D. degree at Indian Insti-
tute of Science (IISc), India. His work is focused on developing
microsensors and electronic modules for healthcare technolo-
gies.
Deepak P is an Assistant Professor at Sri Jayadeva Institute
of Cardiovascular Sciences and Research, India. He obtained
a Fellowship in Clinical EP and Advanced Adult Cardiology at
Mayo Clinic, Rochester. Before his fellowship, he worked as
Ex-Assistant Professor in Medicine at Mayo Clinic, Rochester,
MN.
Dr. Prasanna Simha Mohan Rao is currently Professor of
Cardiothoracic surgery, Sri Jayadeva Institute of Cardiovas-
cular research. He did his MCh from GS Seth Medical College
and, KEM hospital Mumbai. Areas of interest are translational
research, valve repairs, autologous pericardial valve recon-
struction, blood conservation, optimization of valve design,
atrial fibrillation ablation, endoscopic cardiac surgery, surgery
for severe pulmonary hypertension, the molecular mechanism
of right ventricular failure, low-cost simulators and develop-
ment of low-cost indigenous technologies for cardiac surgery.
He has been PI for various national and international trials
and authored various publications.
Hardik J. Pandya is currently an Assistant Professor in the
Department of Electronic Systems Engineering, Division of
EECS, IISc Bangalore. He received his Ph.D. in microengi-
neering from Indian Institute of Technology Delhi. He fin-
ished his postdoctoral training from the Department of Me-
chanical Engineering, Maryland Robotics Center, University
of Maryland, College Park and subsequently from the Depart-
ment of Medicine, Brigham and Women’s Hospital–Harvard
Medical School. He is a recipient of the prestigious Early Ca-
reer Research Award from Science and Engineering Research
Board, Government of India in 2017. His-research interests
are in healthcare technologies which include integrating bi-
ology/medicine with micro- and nanotechnology to develop
innovative tools to solve unmet clinical problems.