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Liu Y, Song J, Wang S, Liu L, Liu X, Liu Z, Wang Y, Zhao L, Yang X. Ablation apprentices and their first experience of pulmonary vein isolation procedure on paroxysmal atrial fibrillation with different sheaths. J Cardiothorac Surg 2024; 19:437. [PMID: 38997733 PMCID: PMC11245845 DOI: 10.1186/s13019-024-02826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVES This study aimed at exploring how using different kinds of sheaths will affect the very first ablation procedure of apprentices. METHODS 15 patients with paroxysmal atrial fibrillation were randomized to used fixed-curve, conventional steerable or visualized steerable sheath, and received complete isolation of pulmonary veins. All ablations were the very first procedure performed by 15 ablation apprentices. The use of fluoroscopy and catheter stability during the PVI were analyzed. RESULTS Procedure duration was much longer in the fixed-curve group (116.8 ± 27 vs. 62.2 ± 17 vs. 60.4 ± 17, p < 0.001). X-ray exposure was lowest with visualized sheath (17.6 ± 5 vs. 18.6 ± 6 vs. 5.2 ± 6, p < 0.001). CF SD differed significantly, especially at the anterior aspect of LSPV (7.90 ± 2.90 vs. 5.04 ± 2.18 vs. 4.52 ± 2.40, p < 0.001) and posterior aspect of RSPV (6.84 ± 2.79 vs. 3.42 ± 2.04 vs. 3.50 ± 2.30, p < 0.001) in the fixed-curve group. Impedance drop was significantly smaller in the fixed-curve group at the anterior aspect of LSPV (8.74 ± 3.02 vs. 11.49 ± 5.48 vs. 12.57 ± 5.96, p = 0.005). CONCLUSION Even for the very first ablation procedure of an ablation apprentice, the use of steerable sheaths will significantly reduce the procedure duration and improve the catheter stability, but only visualized steerable sheath can reduce fluoroscopic time.
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Affiliation(s)
- Ye Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingjing Song
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Siyu Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lifeng Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xiaoqing Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zheng Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuxing Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lei Zhao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Schlögl S, Schlögl KS, Bengel P, Haarmann H, Bergau L, Rasenack E, Hasenfuss G, Zabel M. Contact force sensing manual catheter versus remote magnetic navigation ablation of atrial fibrillation: a single-center comparison. Heart Vessels 2024; 39:427-437. [PMID: 38189924 PMCID: PMC11006819 DOI: 10.1007/s00380-023-02344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation in combination with contact force sensing (MCN-CF) ablation of atrial fibrillation (AF) is lacking. The primary aim of the present retrospective comparative study was to compare the outcome of RMN versus (vs.) MCN-CF ablation of AF with regards to AF recurrence. Secondary aim was to analyze periprocedural risk, ablation characteristics and repeat procedures. METHODS We retrospectively analyzed 452 patients undergoing a total of 605 ablations of AF: 180 patients were ablated using RMN, 272 using MCN-CF. RESULTS Except body mass index there was no significant difference between groups at baseline. After a mean 1.6 ± 1.6 years of follow-up and 1.3 ± 0.4 procedures, 81% of the patients in the MCN-CF group remained free of AF recurrence compared to 53% in the RMN group (P < 0.001). After analysis of 153 repeat ablations (83 MCN-RF vs. 70 RMN; P = 0.18), there was a significantly higher reconnection rate of pulmonary veins after RMN ablation (P < 0.001). In multivariable Cox-regression analysis, RMN ablation (P < 0.001) and left atrial diameter (P = 0.013) was an independent risk factor for AF recurrence. Procedure time, radiofrequency application time and total fluoroscopy time and fluoroscopy dose were higher in the RMN group without difference in total number of ablation points. Complication rates did not differ significantly between groups (P = 0.722). CONCLUSIONS In our retrospective comparative study, the AF recurrence rate and pulmonary vein reconnection rate is significantly lower with more favorable procedural characteristics and similar complication rate utilizing MCN-CF compared to RMN.
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Affiliation(s)
- Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
| | - Klaudia Stella Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Eva Rasenack
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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Schlögl S, Schlögl KS, Haarmann H, Bengel P, Bergau L, Rasenack E, Hasenfuss G, Zabel M. Remote magnetic navigation versus manual catheter ablation of atrial fibrillation: A single center long-term comparison. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:14-22. [PMID: 34687054 DOI: 10.1111/pace.14392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/07/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation (MCN) ablation of atrial fibrillation (AF) is lacking. The aim of the present prospective observational study was to compare the outcome of RMN versus (vs.) MCN ablation of AF with regards to AF recurrence. METHODS The study comprised 667 consecutive patients with a total of 939 procedures: 287 patients were ablated using RMN, 380 using MCN. RESULTS There was no significant difference between the groups at baseline. After 2.3 ± 2.3 years of follow-up, 23% of the patients in the MCN group remained free of AF recurrence compared to 13% in the RMN group (p < .001). After analysis of 299 repeat ablations (133 MCN, 166 RMN) there was a significantly higher reconnection rate of pulmonary veins after RMN ablation p < .001). In multivariable Cox-regression analysis, RMN ablation was an independent risk factor for AF recurrence besides age, persistent AF, number of isolated pulmonary veins, and left atrial diameter. Procedure time, radiofrequency application time and total number of ablation points were higher in the RMN group. Total fluoroscopy time and total fluoroscopy dose were significantly lower for RMN. Complication rates did not differ between groups (p = .842), although the incidence of significant pericardial effusion was higher in the MCN group (seven cases vs. three in RMN group). CONCLUSIONS In our study the AF recurrence rate and pulmonary vein reconnection rate is higher after RMN ablation with a similar complication rate but reduced probability of pericardial effusion when compared to MCN.
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Affiliation(s)
- Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Klaudia Stella Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Philipp Bengel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,Clinic for Electrophysiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Eva Rasenack
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Göttingen, Germany
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Gopesh T, Wen JH, Santiago-Dieppa D, Yan B, Scott Pannell J, Khalessi A, Norbash A, Friend J. Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders. Sci Robot 2021; 6:6/57/eabf0601. [PMID: 34408094 PMCID: PMC9809155 DOI: 10.1126/scirobotics.abf0601] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/26/2021] [Indexed: 01/05/2023]
Abstract
Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.
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Affiliation(s)
- Tilvawala Gopesh
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | - Jessica H. Wen
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | | | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J. Scott Pannell
- Department of Neurosurgery, University of California San Diego, USA
| | | | | | - James Friend
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA,Department of Surgery, University of California San Diego, USA,To whom correspondence should be addressed; , Medically Advanced Devices Laboratory, 9500 Gilman Drive, La Jolla, CA 92093, USA
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5
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Radiofrequency atrial fibrillation ablation with irrigated tip catheter using remote magnetic navigation compared with conventional manual method. J Interv Card Electrophysiol 2020; 62:95-102. [PMID: 32959178 DOI: 10.1007/s10840-020-00879-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Studies comparing manual catheter navigation (MCN) to remote magnetic navigation (RMN) for atrial fibrillation (AF) ablation showed variable results. OBJECTIVE The aim of this meta-analysis is to compare the safety and clinical outcomes of AF radiofrequency (RF) ablation using MCN versus RMN with irrigated tip catheters. METHODS Medline and the Cochrane Central Register of Controlled Trials (CENTRAL) were queried from inception through January 2019. Studies comparing safety and clinical outcomes of AF ablation with RF using MCN versus RMN with irrigated tip catheters were included. Random effects meta-analysis was used to pool outcomes across studies. Study endpoints included freedom of AF at the end of the study, procedure total time, fluoroscopy time, and complications. RESULTS A total of 14 studies (3 controlled non-randomized trials, 1 prospective observational, and 10 retrospective observational studies) involving 3375 patients (1871 in MCN and 1504 in RMN) were included in this meta-analysis. There was no significant difference between the two groups in terms of freedom of AF (OR 1.08, 95% CI 0.82-1.42, p = 0.52). The MCN group was associated with shorter procedure time (mean difference in minutes - 50.39, 95% CI - 67.99 to - 32.79, p < 0.01), longer fluoroscopy time (mean difference in minutes 18.01, 95% CI 10.73-25.29, p < 0.01), and higher complication rate (OR 2.18, 95% CI 1.24-3.82, p < 0.01). CONCLUSIONS AF ablation utilizing MCN was associated with similar efficacy to RMN but with higher complication rates. Although the procedure time was shorter with MCN, the fluoroscopy time was more prolonged. Randomized clinical studies are needed to further verify these results.
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Noten AME, Géczy T, Yap SC, Kis Z, Szili-Torok T. Introducing a novel catheter-tissue contact feedback feature in robotic navigated catheter ablation: Utility, feasibility, and safety. Heart Rhythm O2 2020; 1:103-110. [PMID: 34113864 PMCID: PMC8183953 DOI: 10.1016/j.hroo.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The quality of catheter–tissue contact is one of the most important determinants of catheter ablation (CA) success. The absence of catheter–tissue contact feedback has been regarded a major limitation of remote magnetic navigation (RMN)–guided CA. The e-Contact module (ECM) is a novel feature designed for RMN that measures the quality of catheter–tissue contact. Objective The purpose of this study was to describe the first clinical experience with this feature and to test its effect on procedural parameters and interference with other ablation equipment during CA procedures as well as its safety. Methods This was a prospective, single-center, 2-phase study investigating ECM use during complex RMN procedures in 30 patients. Impact of ECM on procedural parameters was evaluated in the feasibility phase (FP), and its interference with other equipment was tested in the interference phase (IP) using pacing maneuvers at 3 randomly selected right atrial sites. Intracardiac electrograms were evaluated for disturbances by 2 independent electrophysiologists. Results For FP, mean procedural time was 162 ± 66 minutes, fluoroscopy time 21 ± 9 minutes, and ablation time 34 ± 21 minutes. For IP, no significant differences in pacing capture or thresholds were found (ECM– vs ECM+: site 1: 2.05 vs 2.21 mA; P = .320; site 2: 2.15 vs 2.12 mA; P = .873; site 3: 2.51 vs 2.50 mA; P = .976). Electrogram disturbances did not significantly differ between ECM– and ECM+. No adverse events were reported. Conclusion The ECM is a novel catheter–tissue contact technology designed for RMN-guided CA. Our study suggests that this feature is feasible and does not interfere with other electrophysiology equipment while maintaining an excellent safety profile.
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Affiliation(s)
| | - Tamas Géczy
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Zsuzsanna Kis
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Hwang J, Kim JY, Choi H. A review of magnetic actuation systems and magnetically actuated guidewire- and catheter-based microrobots for vascular interventions. INTEL SERV ROBOT 2020. [DOI: 10.1007/s11370-020-00311-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zhao XX, Li KL, Wang RX, Zheng J, Liu XY, Dang SP, Yu ZM, Zhang CY, Yang XJ. Comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation catheter ablation using robotic magnetic navigation system. Clin Cardiol 2019; 42:418-424. [PMID: 30652336 PMCID: PMC6712313 DOI: 10.1002/clc.23156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/24/2023] Open
Abstract
Background No data exist on comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation (AF) ablation using robotic magnetic navigation system (MNS), respectively. Methods About 151 AF patients were prospectively enrolled and divided into paroxysmal AF group (n = 102) and persistent AF group (n = 49). Circumferential pulmonary vein antrum isolation (CPVI) was performed in all patients. Linear ablation at the left atrial roof and mitral isthmus was performed in patients with persistent AF in addition to CPVI. The procedural time, X‐ray exposure time, acute and long‐term success rates of CPVI, and procedure‐related complications were analyzed. The AF recurrence rates in the two groups were compared during 1 year, and Cox regression was used to analyze the recurrence risk factors. Results The acute success rates of CPVI in the two groups were 98.04% and 97.96%, respectively. There were no significant differences in the procedural time, X‐ray exposure time, and ablation time between the two groups (P > 0.05). No serious complications appeared in either group. The AF ablation success rates were 70.6% and 57.1% for the paroxysmal and persistent groups respectively at 12‐month follow‐up (P = 0.102). AF duration and coronary heart disease prior to ablation were associated with the higher AF recurrence in patients with persistent AF. Conclusion Ablation using MNS is effective and safe both in patients with paroxysmal and persistent AF. AF duration and coronary heart disease prior to ablation are two independent risk factors of AF recurrence in patients with persistent AF postoperatively.
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Affiliation(s)
- Xiao-Xi Zhao
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China.,Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jie Zheng
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiao-Yu Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Shi-Peng Dang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhi-Ming Yu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chang-Ying Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang-Jun Yang
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
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Hügl B, Findeisen Z. The Use of Innovative Technologies to Guide Cardiac Procedures. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2012.9.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The advantages of intracardiac echocardiography (ICE) include shorter procedure times, reduced radiation exposure and the elimination of the need for general anesthesia. It is also effective in the safe performance of transseptal punctures. These have led to its increasing use in electrophysiology (EP) procedures. The use of ICE provides unrestricted access to the cardiac anatomy and guides interventional cardiac procedures by providing high-quality images of intracardiac structures and devices. As well as their use as imaging in catheter ablation of atrial fibrillation and other arrhythmias, ICE ultrasound catheters may be used in cardiac valve repair and the closure of atrial septal defects (ASDs). Integration of ICE catheters with electroanatomical mapping systems that construct three dimensional (3D) images have further increased the application of the technique. The use of magnetic navigation systems (MNS) have conferred further advantages including reduced exposure to fluoroscopy and increased operator comfort. This article presents four clinical cases and reviews clinical studies of these techniques.
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Affiliation(s)
- Burkhard Hügl
- Marienhaus Klinikum St Elisabeth Klinik, Neuwied, Germany
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10
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Sankaran NK, Chembrammel P, Siddiqui A, Snyder K, Kesavadas T. Design and Development of Surgeon Augmented Endovascular Robotic System. IEEE Trans Biomed Eng 2018; 65:2483-2493. [PMID: 29993507 DOI: 10.1109/tbme.2018.2800639] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Inadequate visual and force feedback while navigating surgical tools elevate the risk of endovascular procedures. It also poses occupational hazard due to repeated exposure to X-rays. A teleoperated robotic system that augments surgeon's actions is a solution. METHOD We have designed and developed an endovascular robotic system that augments surgeon's actions using conventional surgical tools, as well as generates feedback in order to ensure safety during the procedure. The reaction force from vasculature is estimated from motor current that drives the surgical tool. Calibration required for force estimation is based on bilevel optimization. Input shaping is used in conjunction with a cascaded controller to avoid large responses due to faster inputs and to track tool position. The design, realization, and testing of our system are presented. RESULTS The responses of the system in comparison with the dynamics model is similar vis-à-vis the same input commands. Any error in the position tracking is reduced by the cascaded controller. Phase-portrait analysis of the system showed that the system is stable. The reaction force estimation is validated against load cell measurements. The safety mechanism in the events of excessive reaction forces while interacting with vasculature is demonstrated. CONCLUSION AND SIGNIFICANCE Our system is a step toward intelligent robots that can assist surgeons during endovascular procedures by monitoring and alerting the surgeons regarding detrimental parameters. It arrests any unintended excursions of the surgical tools or surgeon's actions. This will also eliminate the need for surgeons to be in radiation environment.
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Magalhães LPD, Figueiredo MJDO, Cintra FD, Saad EB, Kuniyoshi RR, Menezes Lorga Filho A, D'Avila ALB, Paola AAVD, Kalil CAA, Moreira DAR, Sobral Filho DC, Sternick EB, Darrieux FCDC, Fenelon G, Lima GGD, Atié J, Mateos JCP, Moreira JM, Vasconcelos JTMD. Executive Summary of the II Brazilian Guidelines for Atrial Fibrillation. Arq Bras Cardiol 2017; 107:501-508. [PMID: 28558087 PMCID: PMC5210453 DOI: 10.5935/abc.20160190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jacob Atié
- Sociedade Brasileira de Arritmias Cardíacas, São Paulo, SP, Brazil
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Yuan S, Holmqvist F, Kongstad O, Jensen SM, Wang L, Ljungström E, Hertervig E, Borgquist R. Long-term outcomes of the current remote magnetic catheter navigation technique for ablation of atrial fibrillation. SCAND CARDIOVASC J 2017; 51:308-315. [DOI: 10.1080/14017431.2017.1384566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shiwen Yuan
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Holmqvist
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ole Kongstad
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Steen M. Jensen
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lingwei Wang
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Ljungström
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Eva Hertervig
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rasmus Borgquist
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
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13
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Da Costa A, Guichard JB, Maillard N, Romeyer-Bouchard C, Gerbay A, Isaaz K. Substantial superiority of Niobe ES over Niobe II system in remote-controlled magnetic pulmonary vein isolation. Int J Cardiol 2017; 230:319-323. [DOI: 10.1016/j.ijcard.2016.12.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/12/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
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14
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Aagaard P, Natale A, Briceno D, Nakagawa H, Mohanty S, Gianni C, Burkhardt JD, DI Biase L. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S38-44. [PMID: 26969222 DOI: 10.1111/jce.12938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.
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Affiliation(s)
- Philip Aagaard
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy.,Division of Cardiology, Stanford University, Stanford, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA.,EP Services, California Pacific Medical Center, San Francisco, California, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Dell Medical School, University of Texas, Austin, Texas, USA
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Luigi DI Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
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15
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Marín-Velásquez JE, Aristizábal-Aristizábal JM, Velásquez-Vélez JE, Duque-Ramírez M, Díaz-Martínez JC, Uribe-Arango W. Navegación remota en la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Da Costa A, Guichard JB, Roméyer-Bouchard C, Gerbay A, Isaaz K. Robotic magnetic navigation for ablation of human arrhythmias. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:331-339. [PMID: 27698569 PMCID: PMC5034914 DOI: 10.2147/mder.s96167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radiofrequency treatment represents the first choice of treatment for arrhythmias, in particular complex arrhythmias and especially atrial fibrillation, due to the greater benefit/risk ratio compared to antiarrhythmic drugs. However, complex arrhythmias such as atrial fibrillation require long procedures with additional risks such as X-ray exposure or serious complications such as tamponade. Given this context, the treatment of arrhythmias using robotic magnetic navigation entails a technique well suited to complex arrhythmias on account of its efficacy, reliability, significant reduction in X-ray exposure for both patient and operator, as well as a very low risk of perforation. As ongoing developments will likely improve results and procedure times, this technology will become one of the most modern technologies for treating arrhythmias. Based on the literature, this review summarizes the advantages and limitations of robotic magnetic navigation for ablation of human arrhythmias.
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Affiliation(s)
- Antoine Da Costa
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Jean Baptiste Guichard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Cécile Roméyer-Bouchard
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Antoine Gerbay
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
| | - Karl Isaaz
- North Hospital, Cardiology Department University of Saint Etienne Jean Monnet, Saint Etienne Cedex 2, France
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Abstract
Magnetic navigation has been established as an alternative to conventional, manual catheter navigation for invasive electrophysiology interventions about a decade ago. Besides the obvious advantage of radiation protection for the operator who is positioned remotely from the patient, there are additional benefits of steering the tip of a very floppy catheter. This manuscript reviews the published evidence from simple arrhythmias in patients with normal cardiac anatomy to the most complex congenital heart disease. This progress was made possible by the introduction of improved catheters and most importantly irrigated-tip electrodes.
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Affiliation(s)
| | - Sonya V Babu-Narayan
- Department of Cardiology, Royal Brompton Hospital; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton Hospital; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK
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Ali A, Plettenburg D, Breedveld P. Steerable Catheters in Cardiology: Classifying Steerability and Assessing Future Challenges. IEEE Trans Biomed Eng 2016; 63:679-93. [DOI: 10.1109/tbme.2016.2525785] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aksu T, Bozyel S, Golcuk E, Yalin K, Guler TE. Atrial Fibrillation Ablation Using Magnetic Navigation Comparison With Conventional Approach During Long-Term Follow-Up. J Atr Fibrillation 2015; 8:1276. [PMID: 27957209 DOI: 10.4022/jafib.1276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/04/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) ablation targeting the circumferential isolation of pulmonary veins (PVI) is an established therapeutic alternative in symptomatic AF patients resistant to anti-arrhythmic medications. The procedure is technically challenging and multiple difficulties must be overcome in order to achieve a successful outcome. The magnetic navigation system (MNS) is a remote catheter control technology which has advantages such as a traumatic catheter design improving the procedural safety, a reduced amount of radiation exposure to both the patient and physician, unrestricted and reproducible catheter maneuverability that allows the access to difficult anatomical situations, and an improved catheter stability leading to better energy delivery. Due to these advantages, MNS is increasingly being used for AF ablation and both acute and chronic success rates are comparable with the conventional technique. The new developments in navigation systems, catheters and new three-dimensional mapping systems are very promising to obviate these concerns. However, MNS is related to longer radiofrequency (RF) application duration and procedure time.
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Affiliation(s)
- Tolga Aksu
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Serdar Bozyel
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Ebru Golcuk
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
| | - Kývanc Yalin
- Kolan Hospital, Department of Cardiology, Istanbul, Turkey
| | - Tumer Erdem Guler
- Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey
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van Marion DMS, Lanters EAH, Wiersma M, Allessie MA, Brundel BBJJM, de Groot NMS. Diagnosis and Therapy of Atrial Fibrillation: The Past, The Present and The Future. J Atr Fibrillation 2015; 8:1216. [PMID: 27957185 DOI: 10.4022/jafib.1216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/05/2015] [Accepted: 01/10/2015] [Indexed: 02/03/2023]
Abstract
Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia. It is a progressive disease, which makes treatment difficult. The progression of AF is caused by the accumulation of damage in cardiomyocytes which makes the atria more vulnerable for AF. Especially structural remodeling and electrical remodeling, together called electropathology are sustainable in the atria and impair functional recovery to sinus rhythm after cardioversion. The exact electropathological mechanisms underlying persistence of AF are at present unknown. High resolution wavemapping studies in patients with different types of AF showed that longitudinal dissociation in conduction and epicardial breakthrough were the key elements of the substrate of longstanding persistent AF. A double layer of electrically dissociated waves propagating transmurally can explain persistence of AF (Double Layer Hypothesis) but the molecular mechanism is unknown. Derailment of proteasis -defined as the homeostasis in protein synthesis, folding, assembly, trafficking, guided by chaperones, and clearance by protein degradation systems - may play an important role in remodeling of the cardiomyocyte. As current therapies are not effective in attenuating AF progression, step-by-step analysis of this process, in order to identify potential targets for drug therapy, is essential. In addition, novel mapping approaches enabling assessment of the degree of electropathology in the individual patient are mandatory to develop patient-tailored therapies. The aims of this review are to 1) summarize current knowledge of the electrical and molecular mechanisms underlying AF 2) discuss the shortcomings of present diagnostic instruments and therapeutic options and 3) to present potential novel diagnostic tools and therapeutic targets.
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Affiliation(s)
- Denise M S van Marion
- Department of Clinical Pharmacy and Pharmacology, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva A H Lanters
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marit Wiersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurits A Allessie
- Department of Clinical Pharmacy and Pharmacology, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bianca B J J M Brundel
- Department of Clinical Pharmacy and Pharmacology, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Natasja M S de Groot
- Department of Clinical Pharmacy and Pharmacology, University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Aagaard P, Natale A, Di Biase L. Robotic navigation for catheter ablation: benefits and challenges. Expert Rev Med Devices 2015; 12:457-69. [DOI: 10.1586/17434440.2015.1052406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Koutalas E, Bertagnolli L, Sommer P, Richter S, Rolf S, Breithardt O, Bollmann A, Hindricks G, Arya A. Efficacy and safety of remote magnetic catheter navigation vs. manual steerable sheath-guided ablation for catheter ablation of atrial fibrillation: a case-control study. Europace 2014; 17:232-8. [PMID: 25336662 DOI: 10.1093/europace/euu224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Data comparing remote magnetic catheter navigation (RMN) to manual catheter navigation (MCN) using steerable sheath for ablation of atrial fibrillation (AF) is lacking. The aim of the present case-control study was to seek AF recurrence data after AF ablation using RMN in comparison to MCN using steerable sheath in patients with either paroxysmal or persistent AF. METHODS AND RESULTS This study comprised 140 patients with AF (50% paroxysmal). Seventy were ablated utilizing RMN and 70 with MCN. Primary endpoint was defined as the time to first recurrence after index procedure. After 28.8 ± 18.9 months of follow-up, more patients in the MCN group using steerable sheath remained free of recurrence compared with RMN group [(59.1 vs. 40%, respectively, P = 0.031), in patients with persistent AF P = 0.057, while in patients with paroxysmal AF, P = 0.18]. Index procedure time (223.6 ± 44.2 vs. 170.8 ± 51.8 min, P < 0.001) and radiofrequency application time (75.4 ± 20.9 vs. 56.6 ± 24.9 min, P < 0.001) were longer in the RMN group; however, the respective total fluoroscopy time (13.7 ± 7.8 vs. 36.6 ± 12.7 min, P < 0.001) was significantly shorter. In multivariable Cox-regression analysis, RMN was the only factor independently associated with shorter time to first recurrence during follow-up (P = 0.048). Complication rate did not differ significantly between groups (P = 0.056), although the incidence of significant pericardial effusion was higher in the MCN group (3 cases vs. 0 in RMN group). CONCLUSION Although in patients with persistent AF, the recurrence rate is higher in RMN group, the outcome is comparable between RMN and MCN groups in patients with paroxysmal AF. A multicentre prospective randomized study is warranted to clarify this issue.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Livio Bertagnolli
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Phillip Sommer
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Sergio Richter
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Ole Breithardt
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
| | - Arash Arya
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany
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Casella M, Russo E, Pizzamiglio F, Conti S, Al-Mohani G, Colombo D, Casula V, D Alessandra Y, Biagioli V, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Marino V, Forleo G, Santangeli P, Di Biase L, Dello Russo A, Natale A, Tondo C. The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab. J Atr Fibrillation 2014; 7:1104. [PMID: 27957101 DOI: 10.4022/jafib.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022]
Abstract
Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.
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Affiliation(s)
- Michela Casella
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Eleonora Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | | | - Sergio Conti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Ghaliah Al-Mohani
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Daniele Colombo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu
| | - Yuri D Alessandra
- Laboratory of immunology and functional genomics, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Viviana Biagioli
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Stefania Riva
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Vittoria Marino
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Giovanni Forleo
- Division of Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St David?s Medical Center, Austin, TX, USA
| | - Antonio Dello Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Andrea Natale
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Claudio Tondo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
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Sohns C, Bergau L, Seegers J, Lüthje L, Vollmann D, Zabel M. Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation. J Interv Card Electrophysiol 2014; 41:75-82. [PMID: 24943245 DOI: 10.1007/s10840-014-9915-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA). METHODS Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA. RESULTS In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p=0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p=0.01) and ablation time (p=0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed. CONCLUSIONS RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.
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Affiliation(s)
- Christian Sohns
- Division of Clinical Electrophysiology, Department of Cardiology and Pneumology, Heart Center, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany,
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Datino T, Arenal A, Pelliza M, Hernández-Hernández J, Atienza F, González-Torrecilla E, Avila P, Bravo L, Fernández-Avilés F. Comparison of the safety and feasibility of arrhythmia ablation using the Amigo Robotic Remote Catheter System versus manual ablation. Am J Cardiol 2014; 113:827-31. [PMID: 24440330 DOI: 10.1016/j.amjcard.2013.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/16/2022]
Abstract
The aim of this study is to evaluate the safety and feasibility of using the Amigo Remote Catheter System (RCS) in arrhythmia ablation procedures. Because Amigo allows the physician to operate all catheter function outside of the radiation field, operator exposure time was also evaluated. This is a nonrandomized, prospective clinical trial conducted at 1 site (identifier: NCT01834872). The study prospectively enrolled 50 consecutive patients (mean age 59 ± 15 years, 72% men) with any type of arrhythmia (23 atrial fibrillation ablation, 12 common atrial flutters, 10 patients with other supraventricular tachycardia, 4 ventricular tachycardia, and 1 patient with palpitations with no arrhythmia induced) referred for catheter ablation, in which we used RCS. Fifty matched ablation procedures (mean age 57 ± 14 years, 70% men) performed during the same time period, without RCS, were enrolled into the control group. Acute ablation success was 96% with RCS and 98% in the manual group. In only 2 cases, the physician switched to manual ablation (1 ventricular tachycardia and 1 accessory pathway) to complete the procedure. There were no complications related to the use of RCS. No differences were observed in total procedure time, total fluoroscopy time, or total radiofrequency delivery compared with the manual group. In procedures performed with RCS, the operator's fluoroscopy exposure time was reduced by 68 ± 16%. In conclusion, arrhythmia ablation with RCS is safe and feasible. Furthermore, it significantly reduces operator's exposure to radiation.
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Affiliation(s)
- Tomás Datino
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Angel Arenal
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mauricio Pelliza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pablo Avila
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Loreto Bravo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Patel D, Natale A, Di Biase L, Burkhardt JD, Wang Y, Sanchez JE, Horton RP, Khan M. Catheter ablation for atrial fibrillation: a promising therapy for congestive heart failure. Expert Rev Cardiovasc Ther 2014; 7:779-87. [DOI: 10.1586/erc.09.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Pappone C, Augello G, Gugliotta F, Santinelli V. Robotic and magnetic navigation for atrial fibrillation ablation. How and why? Expert Rev Med Devices 2014; 4:885-94. [DOI: 10.1586/17434440.4.6.885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Rafii-Tari H, Payne CJ, Yang GZ. Current and emerging robot-assisted endovascular catheterization technologies: a review. Ann Biomed Eng 2013; 42:697-715. [PMID: 24281653 DOI: 10.1007/s10439-013-0946-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022]
Abstract
Endovascular techniques have been embraced as a minimally-invasive treatment approach within different disciplines of interventional radiology and cardiology. The current practice of endovascular procedures, however, is limited by a number of factors including exposure to high doses of X-ray radiation, limited 3D imaging, and lack of contact force sensing from the endovascular tools and the vascular anatomy. More recently, advances in steerable catheters and development of master/slave robots have aimed to improve these practices by removing the operator from the radiation source and increasing the precision and stability of catheter motion with added degrees-of-freedom. Despite their increased application and a growing research interest in this area, many such systems have been designed without considering the natural manipulation skills and ergonomic preferences of the operators. Existing studies on tool interactions and natural manipulation skills of the operators are limited. In this manuscript, new technical developments in different aspects of robotic endovascular intervention including catheter instrumentation, intra-operative imaging and navigation techniques, as well as master/slave based robotic catheterization platforms are reviewed. We further address emerging trends and new research opportunities towards more widespread clinical acceptance of robotically assisted endovascular technologies.
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Affiliation(s)
- Hedyeh Rafii-Tari
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK,
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Remote-controlled magnetic pulmonary vein isolation using a new three-dimensional non-fluoroscopic navigation system: A single-centre prospective study. Arch Cardiovasc Dis 2013; 106:423-32. [DOI: 10.1016/j.acvd.2013.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/21/2013] [Accepted: 04/22/2013] [Indexed: 11/21/2022]
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Catheter ablation in children and young adults: is there an additional benefit from remote magnetic navigation? Neth Heart J 2013; 21:296-303. [PMID: 23595705 PMCID: PMC3661873 DOI: 10.1007/s12471-013-0408-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose Although rare, children and young adults can suffer from significant cardiac arrhythmia, especially in the context of congenital malformations and after cardiac surgery. Methods A total of 62 patients (32 female, median age 20 years) underwent an invasive electrophysiology study between 2008–2011: half had normal cardiac anatomy, whereas the remaining patients had various types of congenital heart disease. All patients were treated using either conventional techniques (CVN) or remote magnetic navigation (RMN). Results Patients treated with the RMN system differed substantially from patients in the CVN group with respect to presence of congenital heart disease (67 % vs. 37 %), previous cardiac surgery (59 % vs. 20 %) or failed previous conventional ablation (22 % vs. 9 %), respectively. Although these more complex arrhythmias resulted in longer median procedure duration (180 vs. 130 min, p = 0.034), the median overall fluoroscopy exposure in the RMN group was significantly lower (4.1 vs. 5.2 min, p = 0.020). Clinical outcome was comparable in both groups without complications caused by the ablation. Conclusions Catheter ablation using remote magnetic navigation is safe and feasible in children and young adults and is especially valuable in patients with abnormal cardiac morphologies. RMN resulted in significantly lower radiation exposure compared with the conventional technique.
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Filgueiras-Rama D, Merino JL. The Future of Pulmonary Vein Isolation - Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation? Arrhythm Electrophysiol Rev 2013; 2:59-64. [PMID: 26835042 DOI: 10.15420/aer.2013.2.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pulmonary vein isolation is the main goal of atrial fibrillation (AF) ablation to date. Lack of isolation is associated with an increased risk of AF recurrences. Precise navigation to specific target sites, catheter stability and appropriate contact force are requisites for effective radiofrequency applications. Conventional manual-guided point-by-point radiofrequency energy delivery shows limitations to reach them, especially when performed by non-experienced electrophysiologists. New technological alternatives are rapidly arising and becoming clinically available to overcome some of the manual-guided radiofrequency delivery shortcomings. Here, we review the most recent clinical data, potential advantages, shortcomings and future directions of the new ablation strategies for pulmonary vein isolation.
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Affiliation(s)
| | - Jose L Merino
- Head of the Robotic Cardiac Electrophysiology and Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
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Sohns C, Sohns JM, Bergau L, Sossalla S, Vollmann D, Luthje L, Staab W, Dorenkamp M, Harrison JL, O'Neill MD, Lotz J, Zabel M. Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation. Europace 2013; 15:1136-42. [DOI: 10.1093/europace/eut059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sohns C, Sohns JM, Vollmann D, Lüthje L, Bergau L, Dorenkamp M, Zwaka PA, Hasenfuß G, Lotz J, Zabel M. Left atrial volumetry from routine diagnostic work up prior to pulmonary vein ablation is a good predictor of freedom from atrial fibrillation. Eur Heart J Cardiovasc Imaging 2013; 14:684-91. [PMID: 23435593 DOI: 10.1093/ehjci/jet017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS This study aimed to identify whether left atrial (LA) volume assessed by multidetector computed tomography (MDCT) is related to the long-term success of pulmonary vein ablation (PVA). MDCT is used to guide PVA for the treatment of atrial fibrillation (AF). MDCT permits accurate sizing of LA dimensions. METHODS AND RESULTS We analysed data from 368 ablation procedures of 279 consecutive patients referred for PVA due to drug-refractory symptomatic AF (age 62 ± 10; 58% men; 71% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 64-MDCT scan for assessment of LA and PV anatomy, LA thrombus evaluation, LA volume estimation, and electroanatomical mapping integration. Within a mean follow-up of 356 ± 128 days, 64% of the patients maintained sinus rhythm after the initial ablation, and 84% when including repeat PVA. LA diameter (P = 0.004), LA volume (P = 0.002), and type of AF (P = 0.001) were independent predictors of AF recurrence in univariate analysis. There was a relatively low correlation between the echocardiographic LA diameter and LA volume from MDCT (P = 0.01, r = 0.5). In multivariate analysis, paroxysmal AF (P < 0.006) and LA volume below the median value of 106 mL (P = 0.042) were significantly associated with the success of PVA, whereas LA diameter was not (P = 0.245). Analysing receiver-operator characteristics, the area under the curve for LA volume was 0.73 (P = 0.001) compared with 0.60 (P = 0.09) for LA diameter from echocardiography. CONCLUSION LA volume assessed by MDCT is a better predictor of AF recurrence after PVA than echocardiograpic LA diameter and can be derived from the pre-procedural imaging data set.
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Affiliation(s)
- Christian Sohns
- Department of Cardiology and Pneumology, Heart Center, Section Clinical Electrophysiology, Georg-August-University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany.
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Catheter ablation of atrial fibrillation guided by a 3D electroanatomical mapping system: a 2-year follow-up study from the Italian Registry On NavX Atrial Fibrillation ablation procedures (IRON-AF). J Interv Card Electrophysiol 2013; 37:87-95. [DOI: 10.1007/s10840-012-9772-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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Szili-Torok T, Akca F. Remote magnetic navigation in atrial fibrillation. Expert Rev Med Devices 2012; 9:249-55. [PMID: 22702255 DOI: 10.1586/erd.12.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) is of profound public health importance and is largely a disease of aging and is responsible for increased morbidity- and mortality-related healthcare expenditures. Catheter ablation to isolate the pulmonary veins has become the therapy of choice for treatment of drug-refractory AF. Procedures can be very challenging and multiple difficulties must be overcome in order to achieve a successful outcome. The magnetic navigation system (MNS) has advantages in catheter maneuverability, stability and reproducibility. Due to the catheter design safety and efficacy of AF, ablation has increased. New developments are being made to allow fully remote ablation procedures in combination with the MNS. However, new technologies are still necessary to improve MNS ablation for AF.
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Da Costa A, Lafond P, Romeyer-Bouchard C, Gate-Martinet A, Bisch L, Nadrouss A, Isaaz K. Remote magnetic navigation and arrhythmia ablation. Arch Cardiovasc Dis 2012; 105:446-53. [DOI: 10.1016/j.acvd.2012.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 02/11/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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Vasilyev NV, Dupont PE, del Nido PJ. Robotics and imaging in congenital heart surgery. Future Cardiol 2012; 8:285-96. [PMID: 22413986 DOI: 10.2217/fca.12.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The initial success seen in adult cardiac surgery with the application of available robotic systems has not been realized as broadly in pediatric cardiac surgery. The main obstacles include extended set-up time and complexity of the procedures, as well as the large size of the instruments with respect to the size of the child. Moreover, while the main advantage of robotic systems is the ability to minimize incision size, for intracardiac repairs, cardiopulmonary bypass is still required. Catheter-based interventions, on the other hand, have expanded rapidly in both application as well as the complexity of procedures and lesions being treated. However, despite the development of sophisticated devices, robotic systems to aid catheter procedures have not been commonly applied in children. In this article, we describe new catheter-like robotic delivery platforms, which facilitate safe navigation and enable complex repairs, such as tissue approximation and fixation, and tissue removal, inside the beating heart. Additional features including the tracking of rapidly moving tissue targets and novel imaging approaches are described, along with a discussion of future prospects for steerable robotic systems.
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Houmsse M, Daoud EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9:59-70. [PMID: 22145841 DOI: 10.1586/erd.11.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation by radiofrequency (RF) energy has successfully eliminated cardiac tachyarrhythmias. RF ablation lesions are created by thermal energy. Electrode catheters with 4-mm-tips have been adequate to ablate arrhythmias located near the endocardium; however, the 4-mm-tip electrode does not readily ablate deeper tachyarrhythmia substrate. With 8- and 10-mm-tip RF electrodes, ablation lesions were larger; yet, these catheters are associated with increased risk for coagulum, char and thrombus formation, as well as myocardial steam rupture. Cooled-tip catheter technology was designed to cool the electrode tip, prevent excessive temperatures at the electrode tip-tissue interface, and thus allow continued delivery of RF current into the surrounding tissue. This ablation system creates larger and deeper ablation lesions and minimizes steam pops and thrombus formation. The purpose of this article is to review cooled-tip RF ablation biophysics and outcomes of clinical studies as well as to discuss future technological improvements.
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Affiliation(s)
- Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, Columbus, USA.
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Muntean B, Gutleben KJ, Heintze J, Vogt J, Horstkotte D, Nölker G. Magnetically guided irrigated gold-tip catheter ablation of persistent atrial fibrillation—techniques, procedural parameters and outcome. J Interv Card Electrophysiol 2012; 35:163-71. [DOI: 10.1007/s10840-012-9689-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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BAI RONG, DI BIASE LUIGI, VALDERRABANO MIGUEL, LORGAT FAIZEL, MLCOCHOVA HANKA, TILZ ROLAND, MEYERFELDT UDO, HRANITZKY PATRICKM, WAZNI OUSSAMA, KANAGARATNAM PRAPA, DOSHI RAHULN, GIBSON DOUGLAS, PISAPIA ANDRÉ, MOHANTY PRASANT, SALIBA WALID, OUYANG FEIFAN, KAUTZNER JOSEF, GALLINGHOUSE GJOSEPH, NATALE ANDREA. Worldwide Experience with the Robotic Navigation System in Catheter Ablation of Atrial Fibrillation: Methodology, Efficacy and Safety. J Cardiovasc Electrophysiol 2012; 23:820-6. [DOI: 10.1111/j.1540-8167.2012.02316.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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BRADFIELD JASON, TUNG RODERICK, MANDAPATI RAVI, BOYLE NOELG, SHIVKUMAR KALYANAM. Catheter Ablation Utilizing Remote Magnetic Navigation: A Review of Applications and Outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1021-34. [DOI: 10.1111/j.1540-8159.2012.03382.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santangeli P, Di Biase L, Burkhardt DJ, Horton R, Sanchez J, Bai R, Pump A, Perez M, Wang PJ, Natale A, Al-Ahmad A. Catheter ablation of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2012; 13:108-24. [DOI: 10.2459/jcm.0b013e32834f2371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Patel D, Khan M. The Role of Atrial Fibrillation Catheter Ablation in Patients with Congestive Heart Failure: "Burning"for a Cure. J Atr Fibrillation 2011. [PMID: 28640927 DOI: 10.4022/jafib.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Atrial Fibrillation (AF) and congestive heart failure (CHF) often co-exist. Catheter ablation is increasingly used to cure AF related to CHF.Clinical evidence supports the feasibil- ity of catheter ablation as a treatment option in drug refractory AF patients with CHF.Investiga- tors have reported an improvement in ejection fraction, quality of life, and functional capacity.
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Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias--a systematic review. J Interv Card Electrophysiol 2011; 34:65-71. [PMID: 22180126 PMCID: PMC3342497 DOI: 10.1007/s10840-011-9645-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/13/2011] [Indexed: 11/18/2022]
Abstract
Objective Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT). Methods The National Library of Medicine’s PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system. Results The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0–17%). In ICMP and NICMP, recurrence rates of 0–30% and 14–50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures. Conclusions RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.
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Konstantinidou M, Wissner E, Chun JK, Koektuerk B, Metzner A, Tilz RR, Rillig A, Fuernkranz A, Wohlmuth P, Ouyang F, Kuck KH. Luminal esophageal temperature rise and esophageal lesion formation following remote-controlled magnetic pulmonary vein isolation. Heart Rhythm 2011; 8:1875-80. [DOI: 10.1016/j.hrthm.2011.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/24/2011] [Indexed: 11/28/2022]
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Gang ES, Nguyen BL, Shachar Y, Farkas L, Farkas L, Marx B, Johnson D, Fishbein MC, Gaudio C, Kim SJ. Dynamically Shaped Magnetic Fields. Circ Arrhythm Electrophysiol 2011; 4:770-7. [DOI: 10.1161/circep.110.959692] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eli S. Gang
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Bich Lien Nguyen
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Yehoshua Shachar
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Leslie Farkas
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Laszlo Farkas
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Bruce Marx
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - David Johnson
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Michael C. Fishbein
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Carlo Gaudio
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
| | - Steven J. Kim
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (E.S.G., B.L.N.); Magnetecs Corp, Inglewood, CA (Y.S., Laszlo F., Leslie F., B.M., D.J.); the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (M.C.F.); the Heart and Great Vessels Department, Umberto I Hospital, Sapienza University of Rome, Italy (B.L.N., C.G.); and St Jude Medical, St Paul, MN (S.J.K.)
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Wissner E, Kuck KH. Catheter ablation of atrial fibrillation: an update for 2011. Interv Cardiol 2011. [DOI: 10.2217/ica.11.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lüthje L, Vollmann D, Seegers J, Dorenkamp M, Sohns C, Hasenfuss G, Zabel M. Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation. Clin Res Cardiol 2011; 100:1003-11. [PMID: 21706198 PMCID: PMC3203998 DOI: 10.1007/s00392-011-0333-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 06/08/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Only limited data exist on the clinical utility of remote magnetic navigation (RMN) for pulmonary vein (PV) ablation. Aim of this prospective study was to evaluate the safety and efficacy of RMN for PV isolation as compared to the manual (CON) approach. METHODS AND RESULTS A total of 161 consecutive patients undergoing circumferential PV isolation were included. Open-irrigated 3.5 mm ablation catheters under the guidance of a mapping system were used. The catheter was navigated with the Stereotaxis Niobe II system in the RMN group (n = 107) and guided manually in the CON group (n = 54). Electrical isolation of all PVs was achieved in 90% of the patients in the RMN group and in 87% in the CON group (p = 0.6). All subjects were followed every 3 months by 7d Holter-ECG. At 12 months of follow-up, 53.5% (RMN) and 55.5% (CON) of the patients were free of any left atrial tachycardia/atrial fibrillation (AF) episode (p = 0.57). Free of symptomatic AF recurrence were 66.3% (RMN) and 62.1% (CON) of the subjects (p = 0.80). Use of RMN was associated with longer procedure duration (p < 0.0001), ablation times (p < 0.0001), and RF current application duration (p < 0.05). In contrast, fluoroscopy time was lower in the RMN group (p < 0.0001). Major complications occurred in 6 of 161 procedures (3.7%), with no significant difference between groups (p = 0.75). CONCLUSION RMN-guided PV ablation provides comparable acute and long-term success rates as compared to manual navigation. Procedural complication rates are similar. The use of RMN is associated with markedly reduced fluoroscopy time, but prolonged ablation and procedure duration.
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Affiliation(s)
- Lars Lüthje
- Division of Cardiology and Pulmology, Heart Center, University of Göttingen, Göttingen, Germany.
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Choi MS, Oh YS, Jang SW, Kim JH, Shin WS, Youn HJ, Jung WS, Lee MY, Seong KB. Comparison of magnetic navigation system and conventional method in catheter ablation of atrial fibrillation: is magnetic navigation system is more effective and safer than conventional method? Korean Circ J 2011; 41:248-52. [PMID: 21731565 PMCID: PMC3116102 DOI: 10.4070/kcj.2011.41.5.248] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/27/2010] [Accepted: 10/11/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although there have been so many reports of catheter ablation of atrial fibrillation (AF) with magnetic navigation system (MNS), it is not necessarily obvious that MNS is more effective than conventional ablation. We performed AF ablation with MNS and compared the clinical outcomes and radiofrequency ablation parameters with those of conventional ablation. SUBJECTS AND METHODS One hundred eleven consecutive patients (conventional group, n=70 vs. MNS group, n=41) undergoing catheter ablation of AF were enrolled. We compared and analyzed the procedural parameters, namely fluoroscopic time, procedural time, acute procedural success and 3 months success rate of both groups. RESULTS The MNS group was associated with slightly larger left atrial size (43.7±6.3 mm vs. 41.2±6.3 mm, p=0.04), significantly longer total procedure time (352±50 minutes vs. 283±75 minutes, p<0.0001), and shorter total fluoroscopic time (99±28 minutes vs. 238±45 minutes, p<0.0001) than the conventional group. The MNS and conventional group did not differ with respect to acute procedural success, AF recurrence, atrial flutter/atrial tachycardia recurrence, or total arrhythmia recurrence. While no complications were observed in the MNS group, eight cases of significant pericardial effusion occurred in the conventional group. CONCLUSION The MNS system seems to be effective and safe in the catheter ablation of AF, particularly in the population of patients with persistent AF and slightly dilated left atria.
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Affiliation(s)
- Min Seok Choi
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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