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Bassil G, Markowitz SM, Liu CF, Thomas G, Ip JE, Lerman BB, Cheung JW. Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches. J Cardiovasc Electrophysiol 2020; 31:739-752. [DOI: 10.1111/jce.14380] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Guillaume Bassil
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Steven M. Markowitz
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Christopher F. Liu
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - James E. Ip
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Bruce B. Lerman
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, New York Presbyterian HospitalWeill Cornell Medical College New York New York
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2
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Fink T, Schlüter M, Kuck KH. From early beginnings to elaborate tools: contribution of German electrophysiology to the interventional treatment of cardiac arrhythmias : The German Cardiac Society welcomes ESC in Munich 2018. Clin Res Cardiol 2018; 107:94-99. [PMID: 30006658 DOI: 10.1007/s00392-018-1319-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Catheter ablation evolved from the early days of cardiac electrophysiology (EP), in which invasive electrophysiological studies were mainly a tool to find the correct diagnosis and to evaluate the most effective anti-arrhythmic drug for the patient. Today, catheter ablation is the most effective treatment option for patients suffering from supraventricular and ventricular arrhythmias. The understanding of cardiac arrhythmias and treatment strategies improved because of physicians and scientists from all over the world. The work of German cardiologists led to new achievements in the field of cardiac EP and catheter ablation. In this article, we summarize selective contributions of German EP centres in the field.
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Affiliation(s)
- Thomas Fink
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
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3
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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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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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5
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Bencsik G. Novel strategies in the ablation of typical atrial flutter: role of intracardiac echocardiography. Curr Cardiol Rev 2015; 11:127-33. [PMID: 25308811 PMCID: PMC4356719 DOI: 10.2174/1573403x10666141013121843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 04/05/2014] [Indexed: 11/22/2022] Open
Abstract
Radiofrequency ablation (RFA) of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Despite a high success rate, ablation of the CTI can be unusually difficult in some cases. Multiple tools like angiography, 3D mapping, remote navigation and intracardiac echocardiography (ICE) have been introduced to facilitate typical flutter ablation. This review article summarizes the clinical value of different strategies and tools used for CTI ablation focusing on the importance of approaches utilizing ICE.
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Affiliation(s)
- Gábor Bencsik
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6. 6724 Szeged, Hungary.
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6
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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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Mansour M, Afzal MR, Gunda S, Pillarisetti J, Heist K, Acha MR, Heard M, Ruskin J, Lakkireddy D. Feasibility of Transseptal Puncture Using a Nonfluoroscopic Catheter Tracking System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:791-6. [PMID: 25712806 DOI: 10.1111/pace.12617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access. METHODS The feasibility of performing TS puncture with MediGuide (MDG) was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation for atrial fibrillation. These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. RESULTS All patients underwent successful TS puncture. Fluoroscopy time for double TS puncture using the MDG system was significantly lower than the control group (0.48 ± 0.17 minutes vs. 5.9 ± 0.65 minutes; P < 0.0001). No major complications occurred during the procedures in either group. CONCLUSIONS TS puncture can be successfully performed using MDG, and results in significant reduction in radiation exposure.
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Affiliation(s)
- Moussa Mansour
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Muhammad R Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Sampath Gunda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Jayasree Pillarisetti
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Moshe Rav Acha
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jeremy Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
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Schoene K, Rolf S, Schloma D, John S, Arya A, Dinov B, Richter S, Bollmann A, Hindricks G, Sommer P. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study. Europace 2015; 17:1117-21. [PMID: 25736724 DOI: 10.1093/europace/euu398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/15/2014] [Indexed: 11/12/2022] Open
Abstract
AIMS Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter. METHODS AND RESULTS We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.). CONCLUSION In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use.
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Affiliation(s)
- Katharina Schoene
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sascha Rolf
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Denis Schloma
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Silke John
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Arash Arya
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Borislav Dinov
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Sergio Richter
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Gerhard Hindricks
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Philipp Sommer
- Heart Center, Department of Electrophysiology, University of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
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Parreira L, Cavaco D, Carmo P, Reis-Santos K, Quaresma R, Teixeira T, Marques M, Adragão P. Remote magnetic navigation for ablation of typical atrial flutter: Long-term results. Rev Port Cardiol 2014; 33:773-9. [PMID: 25444228 DOI: 10.1016/j.repc.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 03/07/2014] [Accepted: 05/17/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION AND AIM Remote magnetic navigation has proved to be effective in the ablation of most supraventricular and ventricular arrhythmias. Initial studies reported worse results with this system compared to conventional ablation for atrial flutter. The aim of this study was to assess the acute and long-term success of atrial flutter ablation with remote magnetic navigation and to retrospectively compare the results obtained with an 8-mm tip catheter versus an irrigated catheter. METHODS We studied 38 consecutive patients, mean age 61 ± 15 years, 28 male, who underwent ablation of typical atrial flutter with the Niobe II remote magnetic navigation system (Stereotaxis). Ablation was performed with an 8-mm tip catheter in 17 patients and with an irrigated-tip catheter in 21 patients. Acute success was defined as the presence of bidirectional isthmus block, and long-term success as absence of symptoms and atrial flutter during Holter monitoring. RESULTS Bidirectional isthmus block was achieved in 37 patients (97%), and the success rate was similar in both groups. Total procedure time was not significantly different between the groups but fluoroscopy time was shorter in the irrigated tip group (13.4 ± 3.7 min vs. 6 ± 4.4 min; p<0.01). The number of applications and total radiofrequency time did not differ. There were no complications. During a follow-up of 32 ± 19 months there were two relapses, one in each group. CONCLUSIONS The Niobe II remote control system for ablation of typical atrial flutter is safe and effective in both the short and long term. The 8-mm and irrigated-tip catheters showed similar safety and efficacy.
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Affiliation(s)
- Leonor Parreira
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal.
| | - Diogo Cavaco
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
| | - Pedro Carmo
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
| | | | - Rita Quaresma
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
| | - Tiago Teixeira
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
| | - Marta Marques
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
| | - Pedro Adragão
- Centro do Ritmo Cardíaco, Hospital da Luz, Lisboa, Portugal
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Parreira L, Cavaco D, Carmo P, Reis-Santos K, Quaresma R, Teixeira T, Marques M, Adragão P. Remote magnetic navigation for ablation of typical atrial flutter: Long-term results. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Muser D, Magnani S, Santangeli P. Ablation of typical atrial flutter using the novel MediGuide 3D catheter tracking system: a review of the literature. Expert Rev Cardiovasc Ther 2014; 12:799-802. [DOI: 10.1586/14779072.2014.925801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kircher S, Rolf S, Hindricks G, Sommer P. Ablation of typical atrial flutter using a novel non-fluoroscopic electromagnetic catheter tracking system. Interv Cardiol 2014. [DOI: 10.2217/ica.14.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Cavo-tricuspid isthmus radiofrequency ablation using a novel remote navigation catheter system in patients with typical atrial flutter. Europace 2013; 16:558-62. [DOI: 10.1093/europace/eut285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vallakati A, Reddy YM, Emert M, Janga P, Mansour MC, Heist EK, Pimentel R, Dendi R, Atkins D, Bommana S, Mahapatra S, Heard M, Ruskin J, Berenbom L, Dawn B, Lakkireddy D. Impact of nonfluoroscopic MediGuide™ tracking system on radiation exposure in radiofrequency ablation procedures (LESS-RADS registry)—an initial experience. J Interv Card Electrophysiol 2013; 38:95-100. [DOI: 10.1007/s10840-013-9825-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/06/2013] [Indexed: 11/30/2022]
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Sommer P, Piorkowski C, Gaspar T, Eitel C, Derndorfer M, Martinek M, Pürerfellner H, Arya A, Hindricks G, Rolf S. MediGuide in supraventricular tachycardia: initial experience from a multicentre registry. ACTA ACUST UNITED AC 2013; 15:1292-7. [DOI: 10.1093/europace/eut090] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Das B, Mandal M, Upadhyay A, Chattopadhyay P, Karak N. Bio-based hyperbranched polyurethane/Fe3O4 nanocomposites: smart antibacterial biomaterials for biomedical devices and implants. Biomed Mater 2013; 8:035003. [PMID: 23532037 DOI: 10.1088/1748-6041/8/3/035003] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The fabrication of a smart magnetically controllable bio-based polymeric nanocomposite (NC) has immense potential in the biomedical domain. In this context, magneto-thermoresponsive sunflower oil modified hyperbranched polyurethane (HBPU)/Fe3O4 NCs with different wt.% of magnetic nanoparticles (Fe3O4) were prepared by an in situ polymerization technique. Fourier-transform infrared, x-ray diffraction, vibrating sample magnetometer, scanning electron microscope, transmission electron microscope, thermal analysis and differential scanning calorimetric were used to analyze various physico-chemical structural attributes of the prepared NC. The results showed good interfacial interactions between HBPU and well-dispersed superparamagnetic Fe3O4, with an average diameter of 7.65 nm. The incorporation of Fe3O4 in HBPU significantly improved the thermo-mechanical properties along with the shape-memory behavior, antibacterial activity, biocompatibility as well as biodegradability in comparison to the pristine system. The cytocompatibility of the degraded products of the NC was also verified by in vitro hemolytic activity and MTT assay. In addition, the in vivo biocompatibility and non-immunological behavior, as tested in Wistar rats after subcutaneous implantation, show promising signs for the NC to be used as antibacterial biomaterial for biomedical device and implant applications.
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Affiliation(s)
- Beauty Das
- Advanced Polymer & Nanomaterial Laboratory, Department of Chemical Sciences, Tezpur University, Tezpur-784028, Assam, India
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Pillai A, Reddy M, Heard M, Vallakati A, Berenbom L, Lakkireddy D. Atrial Flutter Ablation Using MediGuide TM Non-fluoroscopic Catheter Tracking System: A Novel Technology to Reduce Radiation Exposure. J Atr Fibrillation 2012; 5:730. [PMID: 28496782 DOI: 10.4022/jafib.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 10/06/2012] [Accepted: 10/06/2012] [Indexed: 11/10/2022]
Abstract
We describe the first case of cardiac arrhythmia ablation with the novel MediGuideTM non-fluoroscopic catheter tracking system in North America. This new technology uses electromagnetic field to track sensor integrated intracardiac electrophysiology catheters which are projected on pre-recorded fluoroscopy cine loops. This new technology permits catheter tracking in virtual biplane fluoroscopy and enhances spatial resolution of conventional 3D mapping systems while drastically reducing radiation exposure.
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Affiliation(s)
- Anand Pillai
- Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Kansas City, KS
| | - Madhu Reddy
- Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Kansas City, KS
| | | | - Ajay Vallakati
- Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Kansas City, KS
| | - Loren Berenbom
- Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Kansas City, KS
| | - Dhanunjaya Lakkireddy
- Section of Electrophysiology, Bloch Heart Rhythm Center, University of Kansas Hospital, Kansas City, KS
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Sommer P, Wojdyla-Hordynska A, Rolf S, Gaspar T, Eitel C, Arya A, Hindricks G, Piorkowski C. Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system. ACTA ACUST UNITED AC 2012; 15:578-81. [DOI: 10.1093/europace/eus226] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Walters TE, Kistler PM, Kalman JM. Radiofrequency Ablation for Atrial Tachycardia and Atrial Flutter. Heart Lung Circ 2012; 21:386-94. [DOI: 10.1016/j.hlc.2012.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/04/2012] [Indexed: 11/16/2022]
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20
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Kottkamp H. Catheter ablation of cavotricuspid isthmus dependent atrial flutter: manual skills or technology or both? J Cardiovasc Electrophysiol 2012; 23:1001-2. [PMID: 22587662 DOI: 10.1111/j.1540-8167.2012.02358.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hans Kottkamp
- Department of Electrophysiology, Clinic Hirslanden, Zurich, Switzerland.
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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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DINOV BORISLAV, SCHÖNBAUER ROBERT, WOJDYLA-HORDYNSKA AGNIESKA, BRAUNSCHWEIG FRIEDER, RICHTER SERGIO, ALTMANN DAVID, SOMMER PHILIPP, GASPAR THOMAS, BOLLMANN ANDREAS, WETZEL ULRIKE, ROLF SASCHA, PIORKOWSKI CHRISTOPHER, HINDRICKS GERHARD, ARYA ARASH. Long-Term Efficacy of Single Procedure Remote Magnetic Catheter Navigation for Ablation of Ischemic Ventricular Tachycardia: A Retrospective Study. J Cardiovasc Electrophysiol 2012; 23:499-505. [DOI: 10.1111/j.1540-8167.2011.02243.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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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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25
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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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26
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Burkhardt JD, Di Biase L, Natale A. Remote magnetic navigation for atrial fibrillation ablation: is 'As Good as Manual' good enough. Europace 2010; 13:5-6. [DOI: 10.1093/europace/euq380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Miyazaki S, Shah AJ, Xhaët O, Derval N, Matsuo S, Wright M, Nault I, Forclaz A, Jadidi AS, Knecht S, Rivard L, Liu X, Linton N, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. Remote magnetic navigation with irrigated tip catheter for ablation of paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol 2010; 3:585-9. [PMID: 20937723 DOI: 10.1161/circep.110.957803] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The remote magnetic navigation system (MNS) has been used with a nonirrigated magnetic catheter for atrial fibrillation (AF) ablation. The objective of this study was to evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for index pulmonary vein isolation (PVI) in patients with paroxysmal AF (PAF). METHODS AND RESULTS Between January 2008 and June 2009, 30 consecutive patients with drug-resistant PAF underwent circular mapping catheter-guided PVI with MNS (MNS group). The outcomes were compared retrospectively with those of a conventional hand-controlled ablation technique during the same period in 44 consecutive patients (manual group). All 4 pulmonary veins were successfully isolated in both groups except in 4 patients in the MNS group. Radiofrequency and procedure duration were higher in the MNS group (60 ± 27 versus 43 ± 16 minutes; P = 0.0019) than in the manual group (246 ± 50 versus 153 ± 51 minutes; P < 0.0001). In the patients who underwent only PVI, total fluoroscopic time also was longer in the MNS group than in the manual group (58 ± 24 versus 40 ± 14 minutes; P = 0.0002). At 12-month follow-up after a single procedure, 69.0% of the patients in MNS group and 61.8% of patients in manual group were free of atrial tachyarrhythmia without antiarrhythmic drugs. There was no significant difference in the atrial tachyarrhythmia-free survival between the 2 groups (P = 0.961). Cardiac tamponade occurred in 1 patient in the manual group. CONCLUSIONS In patients with PAF, MNS-guided PVI with the newly available irrigated tip magnetic catheter backed up with manual ablation whenever required is feasible. However, it requires longer ablation, fluoroscopy, and procedural times than the conventional approach in the early experience stage.
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Affiliation(s)
- Shinsuke Miyazaki
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
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28
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Arya A, Zaker-Shahrak R, Sommer P, Bollmann A, Wetzel U, Gaspar T, Richter S, Husser D, Piorkowski C, Hindricks G. Catheter ablation of atrial fibrillation using remote magnetic catheter navigation: a case-control study. Europace 2010; 13:45-50. [DOI: 10.1093/europace/euq344] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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29
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Lüthje L, Vollmann D, Seegers J, Sohns C, Hasenfuss G, Zabel M. Interference of remote magnetic catheter navigation and ablation with implanted devices for pacing and defibrillation. Europace 2010; 12:1574-80. [PMID: 20810533 DOI: 10.1093/europace/euq300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Remote magnetic catheter navigation (RMN) may facilitate catheter ablation. However, as the system uses permanent magnets, interference (INF) with devices for pacing [pacemaker (PM)], defibrillation [implantable cardioverter defibrillators (ICD)], or cardiac resynchronisation [cardiac resynchronization therapy (CRT)] may occur. We investigated the effects of the RMN system on implanted arrhythmia devices in a prospective series. METHODS AND RESULTS Prior to RMN-guided electrophysiological procedures, devices were fully interrogated and programmed to VVI 40/min with tachycardia detection off (if applicable). Periprocedural device performance was monitored by 12-lead electrocardiogram, and duration and effect of asynchronous stimulation resulting from INF were evaluated. Following the procedure, devices were again interrogated and system integrity verified. A total of 21 procedures in 18 patients with implanted devices [PM n = 12, ICD n = 3, CRT-pacemaker (P) n = 1, CRT-defibrillation (D) n = 2] were evaluated. No relevant changes in lead parameters or device programming were observed after the procedure. No INF was noted in ICD/CRT-D devices (tachycardia detection off) and in 2 PMs, whereas 10 PMs and 1 CRT-P switched to asynchronous stimulation for 1.8 ± 0.3 h (63 ± 13% of RMN duration) without clinical adverse effects. In one patient, ventricular tachycardia (VT) degenerating in ventricular fibrillation occurred, but no causal relation between INF and VT initiation could be ascertained. CONCLUSION This prospective data provide no evidence that using RMN in patients with implanted arrhythmia devices may cause persistent device dysfunction. Asynchronous PM stimulation is common without negative clinical consequences. Although a causal role of INF for the VT observed seems unlikely, risks and benefits of RMN utilization should carefully be weighed for each patient with an implanted arrhythmia device.
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Affiliation(s)
- Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
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ARYA ARASH, EITEL CHARLOTE, BOLLMANN ANDREAS, WETZEL ULRIKE, SOMMER PHILLIPP, GASPAR THOMAS, HUSSER DANIELLA, PIORKOWSKI CHRISTOPHER, HINDRICKS GERHARD. Catheter Ablation of Scar-Related Ventricular Tachycardia in Patients with Electrical Storm Using Remote Magnetic Catheter Navigation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1312-8. [DOI: 10.1111/j.1540-8159.2010.02818.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen J, Hoff PI, Solheim E, Schuster P, Off MK, Ohm OJ. [Magnetic navigation for ablation of cardiac arrhythmias]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1467-70. [PMID: 20706307 DOI: 10.4045/tidsskr.09.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The first use of magnetic navigation for radiofrequency ablation of supraventricular tachycardias, was published in 2004. Subsequently, the method has been used for treatment of most types of tachyarrhythmias. This paper provides an overview of the method, with special emphasis on usefulness of a new remote-controlled magnetic navigation system. MATERIAL AND METHODS The paper is based on our own scientific experience and literature identified through a non-systematic search in PubMed. RESULTS The magnetic navigation system consists of two external electromagnets (to be placed on opposite sides of the patient), which guide an ablation catheter (with a small magnet at the tip of the catheter) to the target area in the heart. The accuracy of this procedure is higher than that with manual navigation. Personnel can be quickly trained to use remote magnetic navigation, but the procedure itself is time-consuming, particularly for patients with atrial fibrillation. The major advantage is a considerably lower radiation burden to both patient and operator, in some studies more than 50 %, and a corresponding reduction in physical strain on the operator. The incidence of procedure-related complications seems to be lower than that observed with use of manually operated ablation catheters. Work is ongoing to improve magnetic ablation catheters and methods that can simplify mapping procedures and improve efficacy of arrhythmia ablation. The basic cost for installing a complete magnetic navigation laboratory may be three times that of a conventional electrophysiological laboratory. INTERPRETATION The new magnetic navigation system has proved to be applicable during ablation for a variety of tachyarrhythmias, but is still under development.
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Affiliation(s)
- Jian Chen
- Hjerteavdelingen, Haukeland universitetssykehus, 5021 Bergen, Norway.
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EITEL CHARLOTTE, HINDRICKS GERHARD, SOMMER PHILIPP, WETZEL ULRIKE, BOLLMANN ANDREAS, GASPAR THOMAS, PIORKOWSKI CHRISTOPHER, ARYA ARASH. Safety of Remote Magnetic Navigation in Patients With Pacemakers and Implanted Cardioverter Defibrillators. J Cardiovasc Electrophysiol 2010; 21:1130-5. [DOI: 10.1111/j.1540-8167.2010.01777.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vollmann D, Lüthje L, Seegers J, Hasenfuss G, Zabel M. Remote Magnetic Catheter Navigation for Cavotricuspid Isthmus Ablation in Patients With Common-Type Atrial Flutter. Circ Arrhythm Electrophysiol 2009; 2:603-10. [DOI: 10.1161/circep.109.884411] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Conventional catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter is a widely applied standard therapy. Remote magnetic catheter navigation (RMN) may provide benefits for different ablation procedures, but its efficacy for CTI ablation has not been evaluated in a randomized, controlled trial.
Methods and Results—
Ninety patients undergoing de novo ablation of atrial flutter were randomly assigned to conventional manual (n=45) or RMN-guided (n=45) CTI ablation with an 8-mm-tip catheter. Complete bidirectional isthmus block was achieved in 84% (RMN) and 91% (conventional catheter ablation) of the cases (
P
=0.52). RMN was associated with shorter fluoroscopy time (median, 10.6 minutes; interquartile range [IQR], 7.6 to 19.9, versus 15.0 minutes; IQR, 11.5 to 23.1;
P
=0.043) but longer total radiofrequency application (17.1 minutes; IQR, 8.6 to 25, versus 7.5 minutes; IQR, 3.6 to 10.9;
P
<0.0001), ablation time (55 minutes; IQR, 28 to 76, versus 17 minutes; IQR, 7 to 31;
P
<0.0001), and procedure duration (114�35 versus 77�24 minutes,
P
<0.0001). Procedure duration in the RMN group did not decrease significantly with case experience. Long-term procedure success, defined as achievement of complete CTI block and freedom from atrial flutter recurrence during 6 months of follow-up, was lower in the RMN group (73% versus 89%,
P
=0.063). Right atrial angiography after ablation revealed no significant differences between groups in terms of right atrial diameter or CTI length, morphology, and angulation. Furthermore, none of these parameters was predictive for difficult (ablation time >20 minutes) or unsuccessful ablation.
Conclusions—
RMN-guided CTI ablation is associated with reduced radiation exposure but prolonged ablation and procedure times as compared with conventional catheter navigation. Our findings suggest that ablation lesions produced with an RMN-guided 8-mm catheter are less effective irrespective of CTI anatomy.
Trial Registration—
clinicaltrials.gov Identifier: NCT00560872
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Affiliation(s)
- Dirk Vollmann
- From the Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany
| | - Lars Lüthje
- From the Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany
| | - Joachim Seegers
- From the Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany
| | - Gerd Hasenfuss
- From the Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany
| | - Markus Zabel
- From the Division of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany
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HAGHJOO MAJID, HINDRICKS GERHARD, BODE KERSTIN, PIORKOWSKI CHRISTOPHER, BOLLMANN ANDREAS, ARYA ARASH. Initial Clinical Experience with the New Irrigated Tip Magnetic Catheter for Ablation of Scar-Related Sustained Ventricular Tachycardia: A Small Case Series. J Cardiovasc Electrophysiol 2009; 20:935-9. [DOI: 10.1111/j.1540-8167.2008.01416.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Robotic magnetic navigation for ablation of human arrhythmias: initial experience. Arch Cardiovasc Dis 2009; 102:419-25. [PMID: 19520327 DOI: 10.1016/j.acvd.2009.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 02/07/2009] [Accepted: 02/11/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Magnetic navigation system (MNS) (Niobe, Stereotaxis, Saint-Louis, Missouri, USA) allows remote control of a radiofrequency ablation catheter using a steerable magnetic field and a catheter advancement system. AIMS We report our initial experience of ablation of human arrhythmias using the MNS. METHODS Eighty-four patients (mean age 54+/-17years; 39 women) had an electrophysiologic study followed by ablation with the MNS using non-irrigated 4, 8 and 3.5mm-tip catheters with three distal magnets. All patients were symptomatic, with commonly-accepted indications for ablation: atrioventricular nodal re-entrant tachycardia (AVNRT; n=37); typical atrial flutter (n=15); accessory pathway (n=12); atypical atrial flutter (n=7); ventricular tachycardia (n=7); atrial tachycardia (n=3); paroxysmal atrial fibrillation (n=3). Electroanatomical mapping was used for atrial flutter, atrial fibrillation, atrial tachycardia and ventricular tachycardia procedures (29 patients, 34%). RESULTS Ablation was performed successfully in 69 (82%) patients. In 15 patients (18%), MNS technique was unsuccessful: seven typical atrial flutters, four accessory pathways, two left atrial flutters after atrial fibrillation ablation, one ventricular tachycardia and one AVNRT; in all these cases except one typical atrial flutter and two left atrial flutters, success was obtained by switching to the manual technique by means of an irrigated catheter. Total fluoroscopy time was 14+/-11minutes; operator exposure fluoroscopy time was 1.5+/-0.6minutes; procedure time was 169+/-72minutes. CONCLUSION MNS ablation is a feasible treatment for various human arrhythmias, with a high success rate. Mapping with a magnetic catheter is safe. However, magnetic ablation of typical atrial flutter remains challenging, probably because of insufficient pressure for cavotricuspid isthmus ablation.
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