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Erin O, Raval S, Schwehr TJ, Pryor W, Barnoy Y, Bell A, Liu X, Mair LO, Weinberg IN, Krieger A, Diaz-Mercado Y. Enhanced Accuracy in Magnetic Actuation: Closed-loop Control of a Magnetic Agent with Low-Error Numerical Magnetic Model Estimation. IEEE Robot Autom Lett 2022; 7:9429-9436. [PMID: 36544557 PMCID: PMC9762677 DOI: 10.1109/lra.2022.3191047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Magnetic actuation holds promise for wirelessly controlling small, magnetic surgical tools and may enable the next generation of ultra minimally invasive surgical robotic systems. Precise torque and force exertion are required for safe surgical operations and accurate state control. Dipole field estimation models perform well far from electromagnets but yield large errors near coils. Thus, manipulations near coils suffer from severe (10×) field modeling errors. We experimentally quantify closed-loop magnetic agent control performance by using both a highly erroneous dipole model and a more accurate numerical magnetic model to estimate magnetic forces and torques for any given robot pose in 2D. We compare experimental measurements with estimation errors for the dipole model and our finite element analysis (FEA) based model of fields near coils. With five different paths designed for this study, we demonstrate that FEA-based magnetic field modeling reduces positioning root-mean-square (RMS) errors by 48% to 79% as compared with dipole models. Models demonstrate close agreement for magnetic field direction estimation, showing similar accuracy for orientation control. Such improved magnetic modelling is crucial for systems requiring robust estimates of magnetic forces for positioning agents, particularly in force-sensitive environments like surgical manipulation.
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Affiliation(s)
- Onder Erin
- Mechanical Engineering Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Suraj Raval
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA
| | - Trevor J Schwehr
- Mechanical Engineering Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Will Pryor
- Computer Science Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Yotam Barnoy
- Computer Science Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Adrian Bell
- Mechanical Engineering Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Xiaolong Liu
- Mechanical Engineering Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Lamar O Mair
- Division of Magnetic Manipulation & Particle Research, Weinberg Medical Physics, Inc., North Bethesda, MD 20852, USA
| | - Irving N Weinberg
- Division of Magnetic Manipulation & Particle Research, Weinberg Medical Physics, Inc., North Bethesda, MD 20852, USA
| | - Axel Krieger
- Mechanical Engineering Department, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Yancy Diaz-Mercado
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA
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ROY KARINE, GOMEZ-PULIDO FEDERICO, ERNST SABINE. Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S45-56. [DOI: 10.1111/jce.12903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- KARINE ROY
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - FEDERICO GOMEZ-PULIDO
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - SABINE ERNST
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Research Unit, National Heart and Lung Institute; Imperial College London; London UK
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Uemura H. Surgical and catheter procedures in adult congenital heart disease: simple national statistics of the UK tell us something. Gen Thorac Cardiovasc Surg 2013; 61:376-89. [DOI: 10.1007/s11748-013-0266-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Indexed: 01/08/2023]
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Filgueiras-Rama D, Estrada A, Shachar J, Castrejón S, Doiny D, Ortega M, Gang E, Merino JL. Remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures. J Vis Exp 2013. [PMID: 23628883 PMCID: PMC3665328 DOI: 10.3791/3658] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate.
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MANTZIARI LILIAN, SUMAN-HORDUNA IRINA, GUJIC MARKO, JONES DAVIDG, WONG TOM, MARKIDES VIAS, FORAN JOHNP, ERNST SABINE. Use of Asymmetric Bidirectional Catheters with Different Curvature Radius for Catheter Ablation of Cardiac Arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:757-63. [DOI: 10.1111/pace.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 12/15/2012] [Accepted: 12/30/2012] [Indexed: 11/28/2022]
Affiliation(s)
- LILIAN MANTZIARI
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - IRINA SUMAN-HORDUNA
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - MARKO GUJIC
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - DAVID G. JONES
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - TOM WONG
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - VIAS MARKIDES
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - JOHN P. FORAN
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
| | - SABINE ERNST
- Cardiology Department; Royal Brompton and Harefield Foundation Trust; London; UK
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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Mantziari L, Suman-Horduna I, Babu-Narayan SV, Ernst S. Advanced ablation strategies for management of post-surgical atrial arrhythmias. Glob Cardiol Sci Pract 2013; 2013:140-8. [PMID: 24689014 PMCID: PMC3963742 DOI: 10.5339/gcsp.2013.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/22/2013] [Indexed: 11/05/2022] Open
Abstract
Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.
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Affiliation(s)
- Lilian Mantziari
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
| | | | | | - Sabine Ernst
- Cardiology Department, Royal Brompton and Harefield Hospital, London, UK
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Kim JJ, Macicek SL, Decker JA, Kertesz NJ, Friedman RA, Cannon BC. Magnetic Versus Manual Catheter Navigation for Ablation of Free Wall Accessory Pathways in Children. Circ Arrhythm Electrophysiol 2012; 5:804-8. [DOI: 10.1161/circep.111.969485] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Transcatheter ablation of accessory pathway (AP)–mediated tachycardia is routinely performed in children. Little data exist regarding the use of magnetic navigation (MN) and its potential benefits for ablation of AP-mediated tachycardia in this population.
Methods and Results—
We performed a retrospective review of prospectively gathered data in children undergoing radiofrequency ablation at our institution since the installation of MN (Stereotaxis Inc, St. Louis, MO) in March 2009. The efficacy and safety between an MN-guided approach and standard manual techniques for mapping and ablation of AP-mediated tachycardia were compared. During the 26-month study period, 145 patients underwent radiofrequency ablation for AP-mediated tachycardia. Seventy-three patients were ablated with MN and 72 with a standard manual approach. There were no significant differences in demographic factors between the 2 groups with a mean cohort age of 13.1±4.0 years. Acute success rates were equivalent with 68 of 73 (93.2%) patients in the MN group being successfully ablated versus 68 of 72 (94.4%) patients in the manual group (
P
=0.889). During a median follow-up of 21.4 months, there were no recurrences in the MN group and 2 recurrences in the manual group (
P
=0.388). There were no differences in time to effect, number of lesions delivered, or average ablation power. There was also no difference in total procedure time, but fluoroscopy time was significantly reduced in the MN group at 14.0 (interquartile range, 3.8–23.9) minutes compared with the manual group at 28.1 (interquartile range, 15.3–47.3) minutes (
P
<0.001). There were no complications in either group.
Conclusions—
MN is a safe and effective approach to ablate AP-mediated tachycardia in children.
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Affiliation(s)
- Jeffrey J. Kim
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Scott L. Macicek
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Jamie A. Decker
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Naomi J. Kertesz
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Richard A. Friedman
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Bryan C. Cannon
- From the Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
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Muller L, Saeed M, Wilson MW, Hetts SW. Remote control catheter navigation: options for guidance under MRI. J Cardiovasc Magn Reson 2012; 14:33. [PMID: 22655535 PMCID: PMC3461467 DOI: 10.1186/1532-429x-14-33] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI) is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. Steering catheters by remote control under MRI guidance offers unique challenges and opportunities. METHODS In this review, the benefits and limitations of MRI-guided remote control intervention are addressed, and the tools for guiding such interventions in the magnetic environment are summarized. Designs for remote control catheter guidance include a catheter tip electromagnetic microcoil design, a ferromagnetic sphere-tipped catheter design, smart material-actuated catheters, and hydraulically actuated catheters. Remote control catheter guidance systems were compared and contrasted with respect to visualization, safety, and performance. Performance is characterized by bending angles achievable by the catheter, time to achieve bending, degree of rotation achievable, and miniaturization capacity of the design. Necessary improvements for furthering catheter design, especially for use in the MRI environment, are addressed, as are hurdles that must be overcome in order to make MRI guided endovascular procedures more accessible for regular use in clinical practice. CONCLUSIONS MR-guided endovascular interventions under remote control steering are in their infancy due to issues regarding safety and reliability. Additional experimental studies are needed prior to their use in humans.
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Affiliation(s)
- Leah Muller
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, L-352, San Francisco, CA, 94143-0628, USA
| | - Maythem Saeed
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, L-352, San Francisco, CA, 94143-0628, USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, L-352, San Francisco, CA, 94143-0628, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, L-352, San Francisco, CA, 94143-0628, USA
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SZILI-TOROK TAMAS, SCHWAGTEN BRUNO, AKCA FERDI, BAUERNFEIND TAMAS, ABKENARI LARADABIRI, HAITSMA DAVID, BELLE YVESVAN, GROOT NATASJADE, JORDAENS LUC. Catheter Ablation of Ventricular Tachycardias Using Remote Magnetic Navigation: A Consecutive Case-Control Study. J Cardiovasc Electrophysiol 2012; 23:948-54. [DOI: 10.1111/j.1540-8167.2012.02340.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas D, Scholz EP, Schweizer PA, Katus HA, Becker R. Initial experience with robotic navigation for catheter ablation of paroxysmal and persistent atrial fibrillation. J Electrocardiol 2012; 45:95-101. [DOI: 10.1016/j.jelectrocard.2011.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Indexed: 10/18/2022]
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12
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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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Bauernfeind T, Akca F, Schwagten B, de Groot N, Van Belle Y, Valk S, Ujvari B, Jordaens L, Szili-Torok T. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias. Europace 2011; 13:1015-21. [PMID: 21508006 PMCID: PMC3120134 DOI: 10.1093/europace/eur073] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aims We aimed to evaluate the safety and long-term efficacy of the magnetic navigation system (MNS) in a large number of patients. The MNS has the potential for improving safety and efficacy based on atraumatic catheter design and superior navigation capabilities. Methods and results In this study, 610 consecutive patients underwent ablation. Patients were divided into two age- and sex-matched groups. Ablations were performed either using MNS (group MNS, 292) or conventional manual ablation [group manual navigation (MAN), 318]. The following parameters were analysed: acute success rate, fluoroscopy time, procedure time, complications [major: pericardial tamponade, permanent atrioventricular (AV) block, major bleeding, and death; minor: minor bleeding and temporary AV block]. Recurrence rate was assessed during follow-up (15 ± 9.5 months). Subgroup analysis was performed for the following groups: atrial fibrillation, isthmus dependent and atypical atrial flutter, atrial tachycardia, AV nodal re-entrant tachycardia, circus movement tachycardia, and ventricular tachycardia (VT). Magnetic navigation system was associated with less major complications (0.34 vs. 3.2%, P = 0.01). The total numbers of complications were lower in group MNS (4.5 vs. 10%, P = 0.005). Magnetic navigation system was equally effective as MAN in acute success rate for overall groups (92 vs. 94%, P = ns). Magnetic navigation system was more successful for VTs (93 vs. 72%, P < 0.05). Less fluoroscopy was used in group MNS (30 ± 20 vs. 35 ± 25 min, P < 0.01). There were no differences in procedure times and recurrence rates for the overall groups (168 ± 67 vs. 159 ± 75 min, P = ns; 14 vs. 11%, P = ns; respectively). Conclusions Our data suggest that the use of MNS improves safety without compromising efficiency of ablations. Magnetic navigation system is more effective than manual ablation for VTs.
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Affiliation(s)
- Tamas Bauernfeind
- Department of Cardiology, Thoraxcenter, Clinical Electrophysiology, Erasmus MC, Postbus 2040, S Gravendijkwal 230, Kamer BD416, 3000 CA Rotterdam, The Netherlands
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15
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Burkhardt JD, Di Biase L, Horton R, Schweikert RA, Natale A. Remote Navigation and Electroanatomic Mapping in the Pericardial Space. Card Electrophysiol Clin 2010; 2:121-125. [PMID: 28770730 DOI: 10.1016/j.ccep.2009.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mapping and ablation in the pericardial space has been shown to be beneficial for the treatment of different supraventricular and ventricular arrhythmias. The percutaneous subxiphoid approach is the most frequently used approach to access the pericardial space. Mapping and ablation in this space may be challenging because it is an open space without obstacles where catheters can move freely, making some locations difficult to reach. Remote magnetic navigation is a modern way to overcome many of the limitations the electrophysiologist encounters during mapping and ablation of arrhythmias in the pericardial space. This article recounts the authors' experiences and reviews the limited data on this topic.
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Affiliation(s)
- J David Burkhardt
- Texas Cardiac Arrhythmia Institute at St David's Medical Center, 1015 East 32nd Street, #516, Austin, TX78705, USA; Stereotaxis, 4320 Forest Park Avenue, Suite 100, St Louis, MO #63108, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St David's Medical Center, 1015 East 32nd Street, #516, Austin, TX78705, USA; Department of Biomedical Engineering, University of Texas, 1 University Station CO 800, Austin, TX78712, USA; Department of Cardiology, University of Foggia, viale L Pinto, 1 71100, Foggia, Italy
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute at St David's Medical Center, 1015 East 32nd Street, #516, Austin, TX78705, USA; Department of Biomedical Engineering, University of Texas, 1 University Station CO 800, Austin, TX78712, USA; Akron General Hospital, Department of Cardiology, 400 Wabash Avenue, Akron, OH 44307, USA
| | - Robert A Schweikert
- Akron General Hospital, Department of Cardiology, 400 Wabash Avenue, Akron, OH 44307, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St David's Medical Center, 1015 East 32nd Street, #516, Austin, TX78705, USA; Department of Biomedical Engineering, University of Texas, 1 University Station CO 800, Austin, TX78712, USA; Division of Cardiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA; Department of Cardiovascular Medicine, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA; EP Services, California Pacific Medical Center, 2333 Buchanan Street, San Francisco, CA 94115, USA
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