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Animal Experiment of a Novel Neurointerventional Surgical Robotic System with Master-Slave Mode. Appl Bionics Biomech 2021; 2021:8836268. [PMID: 33574888 PMCID: PMC7864736 DOI: 10.1155/2021/8836268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/29/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
In order to inspect and improve the system performance of the neuro-interventional surgical robot and its effectiveness and safety in clinical applications, we conducted ten animal experiments using this robotic system. Cerebral angiography was performed on ten experimental animals, and various mechanical performance indicators, operating time, X-ray radiation dosage to the experimental animals and the experimenter, and arterial damage in the experimental animals were recorded when the robotic system completed cerebral angiography. The results show that the robotic system can successfully complete the cerebral angiography surgery, and the mechanical performance is up to standard. The operating time is almost the same as the physician's operating time. And the mean X-ray radiation dosage received by the experimental animals and experimenter was 0.893 Gy and 0.0859 mSv, respectively. There were no complications associated with damage to the vascular endothelium. The robotic system can basically complete the relevant assessment indicators, and its system performance, effectiveness, and safety in clinical applications meet the standards, basically meeting the requirements of clinical applications of neurointerventional surgery.
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Irrigated vs. Non-irrigated Catheters in the Ablation of Accessory Pathways. J Cardiovasc Transl Res 2019; 13:612-617. [PMID: 31664613 DOI: 10.1007/s12265-019-09926-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
There is a paucity of data comparing irrigated to non-irrigated catheters in the ablation of accessory pathways (AP) in adult patients. Retrospective analysis of first-time AP ablations performed at our institution from May 2010 to June 2017. A total of 69 AP ablations were studied; irrigated catheters were used in 78.3% cases. Mean age was 40.9 ± 14.3 years and 56.7% were male. Among APs, 63.8% were left sided and 56.5% were concealed. The total procedure time was 232.0 ± 89.0 min, ablation time was 3.1 ± 5.1 min, and fluoroscopy time was 13.9 ± 15.4 min. The overall acute success rate of ablation was 62/69 (89%). Success rates trended higher with irrigated catheters in both groups and were significant for the population as a whole (94.4% vs. 73.3%, p = 0.04). Analyzing the entire cohort, success rates were significantly higher in ablations using irrigated catheters.
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van den Bruck JH, Sultan A, Lüker J, Thomas D, Willems S, Weinmann K, Kuniss M, Hochadel M, Senges J, Andresen D, Brachmann J, Kuck KH, Tilz R, Steven D. Remote vs. conventional navigation for catheter ablation of atrial fibrillation: insights from prospective registry data. Clin Res Cardiol 2018; 108:298-308. [PMID: 30159751 DOI: 10.1007/s00392-018-1356-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Robotic (RNS) or magnetic navigation systems (MNS) are available for remotely performed catheter ablation for atrial fibrillation (AF). OBJECTIVE The present study compares remotely assisted catheter navigation (RAN) to standard manual navigation (SMN) and both systems amongst each other. METHODS The analysis is based on a sub-cohort enrolled by five hospitals from the multicenter German ablation Registry. RESULTS Out of 2442 patients receiving catheter ablation of AF, 267 (age 61.4 ± 10.4, 69.7% male) were treated using RAN (RNS n = 187, 7.7% vs. MNS n = 80, 3.3%). Fluoroscopy time [RNS median 17 (IQR 12-25) min vs. MNS 22 (16-32) min; p < 0.001] and procedure duration [RNS 180 (145-220) min vs. MNS 265 (210-305) min; p < 0.001] were significantly different. Comparing RAN (11%) to SMN (89%) fluoroscopy time (RAN 19 (13-27) min, vs. SMN 25 (16-40) min; p < 0.001), energy delivery (RAN 3168 (2280-3840) s vs. SMN 2640 (IQR 1799-3900) s; p = 0.008) and procedure duration [RAN 195 (150-255) min vs. SMN 150 (120-150) min; p = 0.001] differed significantly. In terms of acute and 12 months outcome, no differences were seen between the two systems or in comparison to SMN. CONCLUSION AF ablation can be performed safely, with high acute success rates using RAN. RNS results in less fluoroscopy burden and shorter procedure durations. Compared to SMN, a reduced fluoroscopy burden, prolonged procedure and ablation duration were observed using RAN. Overall, the number of RAN procedures is small suggesting low impact on clinical routine of AF ablation.
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Affiliation(s)
- Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Arian Sultan
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital, Heidelberg, Germany
| | - Stephan Willems
- Department of Electrophysiology, Heart Center University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Weinmann
- Department of Cardiology and Angiology, Helios-Klinikum, Pforzheim, Germany
| | - Malte Kuniss
- Department of Cardiology, Heart Center Kerckhoff-Klinik, Bad Nauheim, Germany
| | | | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | - Roland Tilz
- Department of Cardiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Initial Clinical Trial of Robot of Endovascular Treatment with Force Feedback and Cooperating of Catheter and Guidewire. Appl Bionics Biomech 2018; 2018:9735979. [PMID: 29849763 PMCID: PMC5926525 DOI: 10.1155/2018/9735979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/15/2018] [Indexed: 11/17/2022] Open
Abstract
To evaluate the feasibility and safety of the robot of endovascular treatment (RobEnt) in clinical practice, we carried out a cerebral angiography using this robot system. We evaluated the performance of application of the robot system to clinical practice through using this robotic system to perform the digital subtraction angiography for a patient who was suspected of suffering intracranial aneurysm. At the same time, through comparing the postoperative head nuclear magnetic and blood routine with the preoperative examination, we evaluated the safety of application of the robot system to clinical practice. We performed the robot system to complete the bilateral carotid artery and bilateral vertebral arteriography. The results indicate that there was no obvious abnormality in the patient's cerebral artery. No obvious abnormality was observed in the examination of patients' check-up, head nuclear magnetism, and blood routine after the digital subtraction angiography. From this clinical trial, it can be observed that the robot system can perform the operation of cerebral angiography. The robot system can basically complete the related observation indexes, and its accuracy, effectiveness, stability, and safety basically meet the requirements of clinical application in neurointerventional surgery.
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Lim PCY, Toh JJH, Loh JKXY, Lee ECY, Chong DTT, Tan BY, Ho KL, Ching CK, Teo WS. Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction. J Arrhythm 2017; 33:167-171. [PMID: 28607610 PMCID: PMC5459423 DOI: 10.1016/j.joa.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Background Percutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote controlled magnetic navigation (RMN) has been shown to reduce radiation exposure to patients and physicians compared with conventional manual (MAN) ablation techniques. Methods Catheter ablation for atrial fibrillation was performed utilizing RMN in 214 consecutive patients and MAN ablation techniques in 229 patients. We compared the fluoroscopy and procedural times between RMN and MAN catheter ablation of atrial fibrillation. Secondary objectives included comparing acute procedural success and short-term complication rates between both ablation strategies. Results Fluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; p<0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; p>0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; p=0.07). The rates of acute complications were similar in both groups (2.3% vs 4.8%, respectively; p=0.16). Conclusions In radiofrequency ablation of atrial fibrillation, RMN appears to significantly reduce fluoroscopy time compared with conventional MAN ablation, though at a cost of increased total procedural time, with comparable acute success rates and safety profile. A reduction in procedure and fluoroscopy times is possible with gaining experience.
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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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Magnetic guidance versus manual control: comparison of radiofrequency lesion dimensions and evaluation of the effect of heart wall motion in a myocardial phantom. J Interv Card Electrophysiol 2015; 44:1-8. [PMID: 26123094 DOI: 10.1007/s10840-015-0023-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Magnetic navigation system (MNS) ablation was suspected to be less effective and unstable in highly mobile cardiac regions compared to radiofrequency (RF) ablations with manual control (MC). The aim of the study was to compare the (1) lesion size and (2) stability of MNS versus MC during irrigated RF ablation with and without simulated mechanical heart wall motion. METHODS In a previously validated myocardial phantom, the performance of Navistar RMT Thermocool catheter (Biosense Webster, CA, USA) guided with MNS was compared to manually controlled Navistar irrigated Thermocool catheter (Biosense Webster, CA, USA). The lesion dimensions were compared with the catheter in inferior and superior orientation, with and without 6-mm simulated wall motion. All ablations were performed with 40 W power and 30 ml/ min irrigation for 60 s. RESULTS A total of 60 ablations were performed. The mean lesion volumes with MNS and MC were 57.5 ± 7.1 and 58.1 ± 7.1 mm(3), respectively, in the inferior catheter orientation (n = 23, p = 0.6), 62.8 ± 9.9 and 64.6 ± 7.6 mm(3), respectively, in the superior catheter orientation (n = 16, p = 0.9). With 6-mm simulated wall motion, the mean lesion volumes with MNS and MC were 60.2 ± 2.7 and 42.8 ± 8.4 mm(3), respectively, in the inferior catheter orientation (n = 11, p = <0.01*), 74.1 ± 5.8 and 54.2 ± 3.7 mm(3), respectively, in the superior catheter orientation (n = 10, p = <0.01*). During 6-mm simulated wall motion, the MC catheter and MNS catheter moved 5.2 ± 0.1 and 0 mm, respectively, in inferior orientation and 5.5 ± 0.1 and 0 mm, respectively, in the superior orientation on the ablation surface. CONCLUSIONS The lesion dimensions were larger with MNS compared to MC in the presence of simulated wall motion, consistent with greater catheter stability. However, similar lesion dimensions were observed in the stationary model.
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Abraham P, Abkenari LD, Peters ECH, Szili-Torok T. Feasibility of remote magnetic navigation for epicardial ablation. Neth Heart J 2013; 21:391-5. [PMID: 23722429 PMCID: PMC3751027 DOI: 10.1007/s12471-013-0431-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Percutaneous epicardial mapping and ablation is an emerging method to treat ventricular tachycardias (VT), premature ventricular complexes (PVC), and accessory pathways. The use of a remote magnetic navigation system (MNS) could enhance precision and maintain safety. This multiple case history demonstrates the feasibility and safety of the MNS-guided epicardial approach in mapping and ablation of ischaemic VT, outflow tract PVCs, and a left-sided accessory pathway. All patients had previously undergone endocardial mapping for the same arrhythmia. MNS could present an advantage from more precise navigation for mapping and maintaining catheter stability during energy application.
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Affiliation(s)
- P Abraham
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 's Gravendijkwal 230, Ba 577, 3015 CE, Rotterdam, the Netherlands
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9
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WONG KELVINC, JONES MICHAEL, WEBB TERENCE, QURESHI NORMAN, BASHIR YAVER, BETTS TIMOTHYR, RAJAPPAN KIM. Mitral Isthmus Ablation is Feasible, Efficacious, and Safe Using a Remote Robotic Catheter System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1364-72. [DOI: 10.1111/pace.12201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- KELVIN C.K. WONG
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - MICHAEL JONES
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - TERENCE WEBB
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - NORMAN QURESHI
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - YAVER BASHIR
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - TIMOTHY R. BETTS
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
| | - KIM RAJAPPAN
- Oxford Heart Centre; Oxford University Hospitals NHS Trust; Oxford UK
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Affiliation(s)
- N M S de Groot
- Department of Cardiology, Erasmus Medical Center, Thorax Center BA579 Erasmus MC's Gravendijkwal 230, 3015CE, Rotterdam, the Netherlands,
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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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Proietti R, Pecoraro V, Di Biase L, Natale A, Santangeli P, Viecca M, Sagone A, Galli A, Moja L, Tagliabue L. Remote magnetic with open-irrigated catheter vs. manual navigation for ablation of atrial fibrillation: a systematic review and meta-analysis. Europace 2013; 15:1241-8. [DOI: 10.1093/europace/eut058] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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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Abstract
Four decades of innovations in the field of interventional cardiology are presented as an example for the great growth of high technology in medicine, side by side with the development of general technology and science. The field of percutaneous coronary intervention (PCI) was enabled by the development of X-ray systems, allowing us to view the pathology, and was critically dependent on courageous and imaginative physicians and scientists who developed percutaneous transluminal coronary angioplasty (PTCA), stents, and transarterial aortic valve replacement (TAVR). Today, outstanding research continues to progress, with stem cell research and IPC technologies presenting new challenges and yet taller mountains to climb. The rapid development we have witnessed was due to tight collaborations between clinical and academic institutions and industry. The combination of all these elements, with a proper mechanism to handle conflict of interest, is an essential linkage for any progress in this field. We will continue to see exponential growth of innovations and must be prepared with appropriate bodies to encourage such developments and to provide early-stage funding and support for novel ideas.
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Affiliation(s)
- Rafael Beyar
- To whom correspondence should be addressed. E-mail:
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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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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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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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Ganji Y, Janabi-Sharifi F, Cheema AN. Remote controlled robot assisted cardiac navigation: feasibility assessment and validation in a porcine model. Int J Med Robot 2011; 7:489-95. [PMID: 22113981 DOI: 10.1002/rcs.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 07/01/2011] [Accepted: 08/11/2011] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the recent advances in catheter design and technology, intra-cardiac navigation during electrophysiology procedures remains challenging. Incorporation of imaging along with magnetic or robotic guidance may improve navigation accuracy and procedural safety. In the present study, the in vivo performance of a novel remote controlled Robot Assisted Cardiac Navigation System (RACN) was evaluated in a porcine model. METHODS The navigation catheter and target sensor were advanced to the right atrium using fluoroscopic and intra-cardiac echo guidance. The target sensor was positioned at three target locations in the right atrium (RA) and the navigation task was completed by an experienced physician using both manual and RACN guidance. The navigation time, final distance between the catheter tip and target sensor, and variability in final catheter tip position were determined and compared for manual and RACN guided navigation. RESULTS The experiments were completed in three animals and five measurements recorded for each target location. The mean distance (mm) between catheter tip and target sensor at the end of the navigation task was significantly less using RACN guidance compared with manual navigation (5.02 ± 0.31 vs. 9.66 ± 2.88, p = 0.050 for high RA, 9.19 ± 1.13 vs. 13.0 ± 1.00, p = 0.011 for low RA and 6.77 ± 0.59 vs. 15.66 ± 2.51, p = 0.003 for tricuspid valve annulus). The average time (s) needed to complete the navigation task was significantly longer by RACN guided navigation compared with manual navigation (43.31 ± 18.19 vs. 13.54 ± 1.36, p = 0.047 for high RA, 43.71 ± 11.93 vs. 22.71 ± 3.79, p = 0.043 for low RA and 37.84 ± 3.71 vs. 16.13 ± 4.92, p = 0.003 for tricuspid valve annulus. RACN guided navigation resulted in greater consistency in performance compared with manual navigation as evidenced by lower variability in final distance measurements (0.41 vs. 0.99 mm, p = 0.04). CONCLUSION This study demonstrated the safety and feasibility of the RACN system for cardiac navigation. The results demonstrated that RACN performed comparably with manual navigation, with improved precision and consistency for targets located in and near the right atrial chamber.
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McMahon EM, Jiamsripong P, Katayama M, Chaliki HP, Fatemi M, Belohlavek M. Accurate guidance of a catheter by ultrasound imaging and identification of a catheter tip by pulsed-wave Doppler. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:44-50. [PMID: 22054263 DOI: 10.1111/j.1540-8159.2011.03262.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the advent of numerous minimally invasive medical procedures, accurate catheter guidance has become imperative. We introduce and test an approach for catheter guidance by ultrasound imaging and pulsed-wave (PW) Doppler. METHODS A steerable catheter is fitted with a small piezoelectric crystal at its tip that actively transmits signals driven by a function generator. We call this an active-tip (AT) catheter. In a water tank, we immersed a "target" crystal and a rectangular matrix of four "reference" crystals. Two-dimensional (2D) ultrasound imaging was used for initial guidance and visualization of the catheter shaft, and then PW Doppler mode was used to identify the AT catheter tip and guide it to the simulated target that was also visible in the 2D ultrasound image. Ten guiding trials were performed from random initial positions of the AT catheter, each starting at approximately 8 cm from the target. RESULTS After the ten navigational trials, the average final distance of the catheter tip from the target was 2.4 ± 1.2 mm, and the range of distances from the trials was from a minimum of 1.0 mm to a maximum of 4.5 mm. CONCLUSIONS Although early in the development process, these quantitative in vitro results show promise for catheter guidance with ultrasound imaging and tip identification by PW Doppler.
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Affiliation(s)
- Eileen M McMahon
- Division of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA
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Thakur Y, Jones DL, Skanes A, Yee R, Drangova M. Right-side RF ablation using remote catheter navigation: experimental results in vivo. J Cardiovasc Electrophysiol 2011; 23:81-7. [PMID: 21806702 DOI: 10.1111/j.1540-8167.2011.02142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The close proximity between the interventionalist and patient during catheter-based interventions for cardiac arrhythmia exposes the interventionalist to harmful radiation. A prototype remote catheter navigation system (RCNS) has been developed to reduce occupational dose. The safety, feasibility of this RCNS and a comparison of remote and conventional navigation techniques is investigated in vivo. METHODS Seven anatomical locations in the right side of the heart in porcine models were chosen as navigation targets. Using fluoroscopy and electrogram analysis, an experienced electrophysiology interventionalist manipulated a radiofrequency (RF) ablation catheter to each target using the RCNS and conventional navigation. Success rate, navigation time, exposure, exposure time and procedure time was recorded for all anatomical targets. Time to integrate the RCNS with the procedure suite was also measured. RESULTS All targets were successfully reached with the RCNS and conventional navigation. No erratic catheter motion was observed with the RCNS whereas 1 operation failure occurred. The anatomical targets were found to have the largest effect on navigation time (P < 0.05), exposure (P < 0.05), and exposure time (P < 0.01), although the navigation method had little to no effect on the metrics. These results suggest that remote navigation procedures can be performed with navigation times comparable to conventional bedside navigation. CONCLUSION Remote navigation with the RCNS may present a safe method of reducing occupational dose, while providing comparable navigation time with conventional bedside navigation.
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Affiliation(s)
- Yogesh Thakur
- Graduate Program in Biomedical Engineering, Robarts Research Institute, London, Ontario, Canada.
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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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Birnie D, Healey JS, Krahn AD, Ahmad K, Crystal E, Khaykin Y, Chauhan V, Philippon F, Exner D, Thibault B, Hruczkowski T, Nery P, Keren A, Redfearn D. Prevalence and risk factors for cervical and lumbar spondylosis in interventional electrophysiologists. J Cardiovasc Electrophysiol 2011; 22:957-60. [PMID: 21385267 DOI: 10.1111/j.1540-8167.2011.02041.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED INTRODUCTION The volume and complexity of interventional electrophysiology procedures have increased greatly over the last 20 years. Anecdotal reports from Canada and elsewhere have suggested an important prevalence of neck and back problems in interventional electrophysiologists. METHODS AND RESULTS To quantify the scope of neck and back problems, we surveyed 70 interventional electrophysiologists in Canada using an electronic survey with in person and email reminders. We also surveyed an age- and gender-matched group of noninterventional cardiologists. We received responses from a total of 58 of 70 interventional electrophysiologists (response rate 82.8%). There was a significantly higher prevalence of cervical spondylosis among electrophysiologists compared to matched noninterventional cardiologists (20.7% compared to 5.5%, P = 0.033). There was a trend for increased prevalence of lumbar spondylosis (25.9% compared to 16.7%, P = 0.298). Among electrophysiologists, those with cervical spondylosis were older (49.83 ± 10.48 years compared to 44.57 ± 9.20, P = 0.092) and had worked in the specialty for longer in comparison to unaffected physicians (19.67 ± 10.06 years compared to 13.37 ± 8.97 years, P = 0.039). All other variables including gender, height, weight, BMI, type of lead, weekly average lead time, and % of time standing in electrophysiology laboratory were not different. On multivariable analysis there were no independent predictors of disease. CONCLUSIONS There is a significant increased prevalence of cervical spondylosis among interventional electrophysiologists. Programs to improve ergonomics and minimize time spent wearing lead are needed. The same vigilance that is used to ensure radiation safety in the laboratory should be applied to create ergonomic safety.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, Canada Population Health Research Institute-McMaster University, Canada.
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HOUMSSE MAHMOUD, DAOUD EMILEG. Techniques to Ablate Premature Ventricular Ectopy Arising from the Coronary Sinus System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:e74-7. [DOI: 10.1111/j.1540-8159.2010.02785.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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