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Li C, Zhang G, Zhao B, Xie D, Du H, Duan X, Hu Y, Zhang L. Advances of surgical robotics: image-guided classification and application. Natl Sci Rev 2024; 11:nwae186. [PMID: 39144738 PMCID: PMC11321255 DOI: 10.1093/nsr/nwae186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 08/16/2024] Open
Abstract
Surgical robotics application in the field of minimally invasive surgery has developed rapidly and has been attracting increasingly more research attention in recent years. A common consensus has been reached that surgical procedures are to become less traumatic and with the implementation of more intelligence and higher autonomy, which is a serious challenge faced by the environmental sensing capabilities of robotic systems. One of the main sources of environmental information for robots are images, which are the basis of robot vision. In this review article, we divide clinical image into direct and indirect based on the object of information acquisition, and into continuous, intermittent continuous, and discontinuous according to the target-tracking frequency. The characteristics and applications of the existing surgical robots in each category are introduced based on these two dimensions. Our purpose in conducting this review was to analyze, summarize, and discuss the current evidence on the general rules on the application of image technologies for medical purposes. Our analysis gives insight and provides guidance conducive to the development of more advanced surgical robotics systems in the future.
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Affiliation(s)
- Changsheng Li
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Gongzi Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
| | - Baoliang Zhao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Dongsheng Xie
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Hailong Du
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
| | - Xingguang Duan
- School of Mechatronical Engineering, Beijing Institute of Technology, Beijing 100081, China
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Ying Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Lihai Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100141, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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Dreyfus R, Boehler Q, Lyttle S, Gruber P, Lussi J, Chautems C, Gervasoni S, Berberat J, Seibold D, Ochsenbein-Kölble N, Reinehr M, Weisskopf M, Remonda L, Nelson BJ. Dexterous helical magnetic robot for improved endovascular access. Sci Robot 2024; 9:eadh0298. [PMID: 38354258 DOI: 10.1126/scirobotics.adh0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024]
Abstract
Treating vascular diseases in the brain requires access to the affected region inside the body. This is usually accomplished through a minimally invasive technique that involves the use of long, thin devices, such as wires and tubes, that are manually maneuvered by a clinician within the bloodstream. By pushing, pulling, and twisting, these devices are navigated through the tortuous pathways of the blood vessels. The outcome of the procedure heavily relies on the clinician's skill and the device's ability to navigate to the affected target region in the bloodstream, which is often inhibited by tortuous blood vessels. Sharp turns require high flexibility, but this flexibility inhibits translation of proximal insertion to distal tip advancement. We present a highly dexterous, magnetically steered continuum robot that overcomes pushability limitations through rotation. A helical protrusion on the device's surface engages with the vessel wall and translates rotation to forward motion at every point of contact. An articulating magnetic tip allows for active steerability, enabling navigation from the aortic arch to millimeter-sized arteries of the brain. The effectiveness of the magnetic continuum robot has been demonstrated through successful navigation in models of the human vasculature and in blood vessels of a live pig.
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Affiliation(s)
- R Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - Q Boehler
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Lyttle
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - P Gruber
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - J Lussi
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - C Chautems
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - S Gervasoni
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - J Berberat
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Seibold
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- Institute of Pathology and Molecular Pathology, University of Zurich, Zurich, Switzerland
| | - M Reinehr
- University of Zurich, Zurich, Switzerland
| | - M Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - L Remonda
- Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - B J Nelson
- Multi-Scale Robotics Lab, ETH Zurich, Zurich, Switzerland
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Gagyi RB, Yap SC, Noten AME, Wijchers S, Szili-Torok T. The performance of dipole charge density mapping integrated with robotic magnetic navigation in the treatment of atrial tachycardias. J Interv Card Electrophysiol 2023; 66:2103-2111. [PMID: 37076739 PMCID: PMC10694103 DOI: 10.1007/s10840-023-01552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure. METHODS All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups. RESULTS A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21). CONCLUSIONS AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.
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Affiliation(s)
- Rita B Gagyi
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sing-Chien Yap
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Anna M E Noten
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sip Wijchers
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Tamas Szili-Torok
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands.
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Alipour S, Pourjavadi A, Hosseini SH. Magnetite embedded κ-carrageenan-based double network nanocomposite hydrogel with two-way shape memory properties for flexible electronics and magnetic actuators. Carbohydr Polym 2023; 310:120610. [PMID: 36925232 DOI: 10.1016/j.carbpol.2023.120610] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Shape memory hydrogels attract increasing attention as flexible strain sensors due to their shape recovery property that can improve the lifetime of the sensor. Herein, we have designed a magnetic shape memory hydrogel based on Fe3O4 nanoparticles, carrageenan, and poly (acrylamide-co-acrylic acid) with self-adhesive and conductive properties. The resulting double network hydrogel showed promising actuator and strain sensor applications. Electrical conductivity was observed in this hydrogel without using additional ions. The presence of magnetite nanoparticles increased the tensile strength and temporary shape fixity ratio to around 6.5 MPa and 94.3 %, respectively. The excellent cantilever and catheter-like behavior of the hydrogels were illustrated through magnetic routing by an external magnet. Also, these hydrogels demonstrated suitable performance in the 500 cycles strain sensing tests before and after their initial shape recovery.
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Affiliation(s)
- Sakineh Alipour
- Polymer Research Laboratory, Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Ali Pourjavadi
- Polymer Research Laboratory, Department of Chemistry, Sharif University of Technology, Tehran, Iran.
| | - Seyed Hassan Hosseini
- Department of Chemical Engineering, University of Science and Technology of Mazandaran, Behshahr, Iran
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Sakata K, Tanaka T, Yamashita S, Kobayashi M, Ito M, Yamashiro K. The spatiotemporal electrogram dispersion ablation targeting rotors is more effective for elderly patients than non-elderly population. J Arrhythm 2023; 39:315-326. [PMID: 37324760 PMCID: PMC10264740 DOI: 10.1002/joa3.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Modulating atrial fibrillation (AF) drivers has been proposed as one of the effective ablation strategies for non-paroxysmal AF (non-PAF). However, the optimal non-PAF ablation strategy is still under debate because the exact mechanisms of AF persistence including focal activity and/or rotational activity, are not well-understood. Recently, spatiotemporal electrogram dispersion (STED) assumed to indicate rotors in the form of rotational activity is proposed as an effective target for non-PAF ablation. We aimed to clarify the effectiveness of STED ablation for modulating AF drivers. Methods STED ablation plus pulmonary vein isolation was applied in 161 consecutive non-PAF patients not undergoing previous ablation. STED areas within the entire left and right atria were identified and ablated during AF. After the procedures, the STED ablation's acute and long-term outcomes were investigated. Results (1) Despite a more effective acute outcome of the STED ablation for both AF termination and non-inducibility of atrial tachyarrhythmias (ATAs), Kaplan-Meier curves showed that the 24-month freedom ratio from ATAs was 49%, which resulted from the higher recurrence ratio of atrial tachycardia (AT) rather than AF. (2) A multivariate analysis showed that the determinant of ATA recurrences was only a non-elderly age, not long-standing persistent AF, and an enlarged left atrium, which were conventionally considered as key factors. Conclusions STED ablation targeting rotors was effective in elderly non-PAF patients. Therefore, the main mechanism of AF persistency and the component of the fibrillatory conduction might vary between elders and non-elders. However, we should be careful about post-ablation ATs following substrate modification.
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Affiliation(s)
- Kensuke Sakata
- Alliance for Cardiovascular Diagnostic and Treatment InnovationJohns Hopkin UniversityBaltimoreMarylandUSA
| | - Tomomi Tanaka
- Heart Rhythm CenterTakatsuki General HospitalTakatsukiJapan
| | - Soichiro Yamashita
- Department of CardiologyHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Masanori Kobayashi
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoJapan
| | - Mitsuaki Ito
- Department of Cardiovascular MedicineHyogo Brain and Heart CenterHimejiJapan
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Luo Q, Xie Y, Wu L, Jin Q. Robotic magnetic navigation-guided pulmonary vein isolation in an atrial fibrillation patient with dextrocardia situs inversus: techniques and potential advantages. BMC Cardiovasc Disord 2023; 23:265. [PMID: 37210522 DOI: 10.1186/s12872-023-03308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Dextrocardia with situs inversus (DSI) is a very rare congenital anomaly. Catheter manipulation and ablation of atrial fibrillation (AF) in patients with this anatomical variant is challenging for the operators. This case report presents a safe and effective AF ablation guided by the robotic magnetic navigation (RMN) system in combination with intracardiac echocardiograhy (ICE) in a patient with DSI. CASE PRESENTATION A 64-year-old male with DSI was referred for catheter ablation of symptomatic, drug-refractory paroxysmal AF. One transseptal access was achieved via the left femoral vein under the guidance of ICE. The three-dimensional reconstruction of the left atrium and the pulmonary veins (PVs) were performed by the magnetic catheter using the CARTO and the RMN system. Then, the electroanatomic map and pre-acquired CT images were merged. Finally, bilateral circumferential ablation lines were delivered around the ipsilateral PV ostia to achieve complete PV isolation (PVI). CONCLUSIONS This case demonstrates that AF catheter ablation under the guidance of the RMN system using ICE is feasible and safe in a patient with DSI. Moreover, the combination of these technologies broadly facilitates treatment of patients with complex anatomy, while reducing the risk of complications.
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Affiliation(s)
- Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China.
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Gagyi RB, Noten AM, Wijchers S, Yap SC, Bhagwandien RE, Hoogendijk MG, Szili-Torok T. Dipole charge density mapping integrated in remote magnetic navigation: First-in-human feasibility study. IJC HEART & VASCULATURE 2022; 42:101095. [PMID: 35899072 PMCID: PMC9309500 DOI: 10.1016/j.ijcha.2022.101095] [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: 04/21/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
Aims Robotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures. Material and methods In this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared. Results AcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p < 0.01; 181.0 vs. 131.0 mGy, p = 0.02, respectively). Procedure duration and fluoroscopy use decreased significantly between the first 30 and the last 30 AcQMap-RMN procedures. The AcQMap-RMN system had fewer recurrences after persistent AF ablations and was non-inferior in paroxysmal AF patients compared to CARTO-RMN at 12 months (36.6% vs. 75.0%, p = 0.04, PAF 6.6% vs. 12.5%, p = 0.58; respectively). CA of AT outcomes were better using the AcQMap-RMN system (1 year recurrence 17.1% vs. 38.7%, p < 0.05). Conclusion AcQMap-RMN integration has no negative impact on the excellent safety profile of RMN guided ablations. It improves outcomes of CA procedures for persAF and AT but requires longer procedure times and higher fluoroscopy use during the initial learning phase.
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Dreyfus R, Boehler Q, Nelson BJ. A Simulation Framework for Magnetic Continuum Robots. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3187249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roland Dreyfus
- Multi-Scale Robotics Lab, ETH Zurich, Zürich, Switzerland
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Hwang J, Jeon S, Kim B, Kim J, Jin C, Yeon A, Yi B, Yoon C, Park H, Pané S, Nelson BJ, Choi H. An Electromagnetically Controllable Microrobotic Interventional System for Targeted, Real-Time Cardiovascular Intervention. Adv Healthc Mater 2022; 11:e2102529. [PMID: 35137568 DOI: 10.1002/adhm.202102529] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/28/2022] [Indexed: 12/26/2022]
Abstract
Robotic magnetic manipulation systems offer a wide range of potential benefits in medical fields, such as precise and selective manipulation of magnetically responsive instruments in difficult-to-reach vessels and tissues. However, more preclinical/clinical studies are necessary before robotic magnetic interventional systems can be widely adopted. In this study, a clinically translatable, electromagnetically controllable microrobotic interventional system (ECMIS) that assists a physician in remotely manipulating and controlling microdiameter guidewires in real time, is reported. The ECMIS comprises a microrobotic guidewire capable of active magnetic steering under low-strength magnetic fields, a human-scale electromagnetic actuation (EMA) system, a biplane X-ray imaging system, and a remote guidewire/catheter advancer unit. The proposed ECMIS demonstrates targeted real-time cardiovascular interventions in vascular phantoms through precise and rapid control of the microrobotic guidewire under EMA. Further, the potential clinical effectiveness of the ECMIS for real-time cardiovascular interventions is investigated through preclinical studies in coronary, iliac, and renal arteries of swine models in vivo, where the magnetic steering of the microrobotic guidewire and control of other ECMIS modules are teleoperated by operators in a separate control booth with X-ray shielding. The proposed ECMIS can help medical physicians optimally manipulate interventional devices such as guidewires under minimal radiation exposure.
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Affiliation(s)
- Junsun Hwang
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Sungwoong Jeon
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Beomjoo Kim
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Jin‐young Kim
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Chaewon Jin
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Ara Yeon
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
| | - Byung‐Ju Yi
- Department of Electronic Systems Engineering Hanyang University ERICA Gyeonggi 15588 Republic of Korea
| | - Chang‐Hwan Yoon
- Cardiovascular Center Seoul National University Bundang Hospital Seoul National University College of Medicine Gyeonggi 13620 Republic of Korea
| | - Hun‐Jun Park
- Division of Cardiology Department of Internal Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul 06591 Republic of Korea
| | - Salvador Pané
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
- Multi‐Scale Robotics Lab Institute of Robotics and Intelligent Systems ETH Zurich Tannenstrasse 3 Zurich CH‐8092 Switzerland
| | - Bradley J. Nelson
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
- Multi‐Scale Robotics Lab Institute of Robotics and Intelligent Systems ETH Zurich Tannenstrasse 3 Zurich CH‐8092 Switzerland
| | - Hongsoo Choi
- Department of Robotics Engineering Daegu Gyeongbuk Institute of Science and Technology (DGIST) Daegu 42988 Republic of Korea
- DGIST‐ETH Microrobotics Research Center Daegu 42988 Republic of Korea
- Robotics Research Center DGIST Daegu 42988 Republic of Korea
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Luo Q, Xie Y, Bao Y, Wei Y, Lin C, Zhang N, Ling T, Chen K, Pan W, Wu L, Jin Q. Utilization of steerable sheath improves the efficiency of atrial fibrillation ablation guided by robotic magnetic navigation compared with fixed-curve sheath. Clin Cardiol 2022; 45:482-487. [PMID: 35195273 PMCID: PMC9045062 DOI: 10.1002/clc.23801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background The objective of this study was to assess the impact of steerable sheaths compared with fixed‐curve sheaths on the procedural outcomes of atrial fibrillation (AF) ablation guided by robotic magnetic navigation (RMN). Methods and Results In this retrospective case−control study, 110 patients scheduled for AF catheter ablation were enrolled and divided into two groups. Fifty‐five patients (paroxysmal, 70%) were treated with RMN‐guided ablation utilizing a steerable sheath and another 55 patients (paroxysmal, 70%) were ablated with RMN using a fixed‐curve sheath. Clinical characteristics were similar between the two groups. Compared with the fixed‐curve sheath group, the steerable sheath group procedure time (111.9 ± 25.2 vs. 90.4 ± 20.7 min, p < .001) and radiofrequency (RF) time (35.9 ± 9.0 vs. 30.5 ± 7.4 min, p < .001) were significantly shortened. Additionally, the navigation index was significantly improved (0.41 ± 0.06 vs. 0.48 ± 0.08, p < .001) in the steerable sheath group. By employing a large catheter loop for targeting the right pulmonary veins (PVs), the steerable sheath group significantly reduced the RF delivery time (15.0 ± 3.0 vs. 12.0 ± 2.1 min, p < .001) during right‐side PV isolation (PVI). However, total fluoroscopy time was similar between the two groups (5.6 ± 2.6 vs. 5.0 ± 2.0 min, p > .05). Acute PVI success rates were similar between the two groups. No major or minor complications occurred in either group. Conclusion Appropriate utilization of steerable sheath technology can improve the efficiency of AF ablation guided by RMN, primarily by reducing the total procedure and RF delivery times of right‐side PVI without compromising safety.
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Affiliation(s)
- Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Chen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Pan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gulsen K, Akgun T, Kup A, Uslu A, Kanar BG, Taylan G, Kayan F, Barutcu S, Kepez A, Demir S. Fluoroscopy time and scattered radiation during electrophysiology procedures: analysis of one-year data of a laboratory providing electrophysiology training. Acta Cardiol 2021; 76:236-242. [PMID: 33131407 DOI: 10.1080/00015385.2020.1834249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Patients and medical staff expose to significant radiation during electro-physiological (EP) procedures. There are few data regarding the leading factors of longer fluoroscopy time and higher scattered radiation in a laboratory giving EP training during those interventions. MATERIAL AND METHODS The patients' recordings that underwent EP procedure in a single centre arrhythmia unit from February 2019 to January 2020 were examined. Prospectively collected data regarding procedure duration, fluoroscopy time and total air kerma, demographic characteristics of the patients, type of procedure, success of ablation and the use of electro anatomic mapping were retrospectively evaluated. Predictors of total air kerma were analysed with linear regression analysis. RESULTS Study population consisted of 437 patients with a median age of 47 (39-56); 184 (42.1%) were male. Median fluoroscopy time was 768 (420-1320) seconds and median cumulative air kerma was 369 (191-750) mGy. Fluoroscopy time and cumulative air kerma were significantly lower in diagnostic EP studies compared to other procedures. There was no difference in terms of total air kerma between the procedures other than the diagnostic EP study. In multivariable linear regression analysis; body surface area, fluoroscopy time, not using the electro-anatomical mapping, unsuccessful ablation and atrial flutter ablation were predictors of total air kerma in EP studies performed by trainees. CONCLUSION Scattered radiation during EP procedures performed by in-training operators is related with some factors. Awareness about those may help to effort reducing the harmful effect of ionising radiation.
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Affiliation(s)
- Kamil Gulsen
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey
| | - Ayhan Kup
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Cardiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Gokay Taylan
- Cardiology Department, Trakya University School of Medicine, Edirne, Turkey
| | | | - Suleyman Barutcu
- Cardiology Department, Van Training and Research Hospital, Van, Turkey
| | - Alper Kepez
- Cardiology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Department, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
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12
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Ali A, Dodou D, Smit G, Rink R, Breedveld P. Stabilizing interventional instruments in the cardiovascular system: A classification of mechanisms. Med Eng Phys 2021; 89:22-32. [PMID: 33608122 DOI: 10.1016/j.medengphy.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Positioning and stabilizing a catheter at the required location inside a vessel or the heart is a complicated task in interventional cardiology. In this review we provide a structured classification of catheter stabilization mechanisms to systematically assess their challenges during cardiac interventions. Commercially available, patented, and experimental prototypes of catheters were classified with respect to their stabilizing mechanisms. Subsequently, the classification was used to define requirements for future cardiac catheters and persisting challenges in catheter stabilization. The classification showed that there are two main stabilization mechanisms: surface-based and volume-based. Surface-based mechanisms apply attachment through surface anchoring, while volume-based mechanisms make use of locking through shape or force against the vessel or cardiac wall. The classification provides insight into existing catheter stabilization mechanisms and can possibly be used as a tool for future design of catheter stabilization mechanisms to keep the catheter at a specific location during an intervention. Additionally, insight into the requirements and challenges for catheter stabilization inside the heart and vasculature can lead to the development of more dedicated systems in the future, allowing for intervention- and patient-specific instrument manipulation.
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Affiliation(s)
- Awaz Ali
- PhD candidate at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Dimitra Dodou
- Associate Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Gerwin Smit
- Assistant Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Ruben Rink
- Student Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Paul Breedveld
- Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
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13
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Novel strategy of remote magnetic navigation-guided ablation for ventricular arrhythmias from right ventricle outflow tract. Sci Rep 2020; 10:17839. [PMID: 33082510 PMCID: PMC7575540 DOI: 10.1038/s41598-020-75032-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022] Open
Abstract
The optimized strategy to further increase the success rate of ablation for ventricular arrhythmias (VAs) from the right ventricular outflow tract (RVOT) is challenging. Recent studies have shown that the pulmonary sinus cusp (PSC) region may be the origin of certain RVOT VAs. We evaluated the efficacy of preferential ablation below the pulmonary valve (PV) and alternated radiofrequency delivery in the PSC using remote magnetic navigation (RMN). Sixty-five (65) consecutive patients experiencing VAs with RVOT-like appearance were included in this study. Mapping and ablation were preferentially performed below the PV. Ablation in the PSC would only be attempted when intensified ablation below the PV could not eliminate VAs. Finally, if ablation in the RVOT region failed, the aortic sinus cusp (ASC) would be mapped. Sixty-one (61) of 65 (93.8%) patients achieved procedural success. Except 7 cases of which the VAs were ablated in the ASC, the rest 54 VAs were thought to be originate from the RVOT region. Fifty (50) of 54 VAs were successfully ablated below the PV, and in the presence of a local special signal in the bipolar electrogram a more aggressive ablation was required. Subsequent ablation in the PSC with assistance of the RMN system achieved success in the remaining 4 patients. No complications occurred in this study. Our strategy of using RMN-guided ablation below the PV for VAs of RVOT origin was proved to be effective. PSC mapping and ablation using a magnetic catheter may provide the optimal strategy for treating these types of arrhythmias.
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Rottner L, Waddell D, Lin T, Metzner A, Rillig A. Innovative tools for atrial fibrillation ablation. Expert Rev Med Devices 2020; 17:555-563. [DOI: 10.1080/17434440.2020.1768846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Laura Rottner
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
| | - Daniela Waddell
- Department of Cardiology, Asklepios Klinik Sankt Georg , Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, GenesisCare , Melbourne, Australia
| | - Andreas Metzner
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
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15
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Xie Y, Jin Q, Zhang N, Liu A, Xing C, Jia K, Wei Y, Bao Y, Luo Q, Lin C, Ling T, Chen K, Pan W, Wu L. Strategy of catheter ablation for para‐Hisian premature ventricular contractions with the assistance of remote magnetic navigation. J Cardiovasc Electrophysiol 2019; 30:2929-2935. [DOI: 10.1111/jce.14245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/16/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yun Xie
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Ning Zhang
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Ao Liu
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Chaofan Xing
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Kangni Jia
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Yue Wei
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Yangyang Bao
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Qingzhi Luo
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Changjian Lin
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Tianyou Ling
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Kang Chen
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Wenqi Pan
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
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16
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Jez J, Jadczyk T, Lehar F, Pesl M, Kulik T, Belaskova S, Soucek F, Caluori G, Wojakowski W, Starek Z. Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:387-393. [PMID: 31645769 DOI: 10.5507/bp.2019.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
AIMS This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF). METHODS 146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up. RESULTS Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm2, P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77). CONCLUSIONS Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.
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Affiliation(s)
- Jiri Jez
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomasz Jadczyk
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frantisek Lehar
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Pesl
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomas Kulik
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic
| | - Silvie Belaskova
- Biostatistics, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Filip Soucek
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic
| | - Guido Caluori
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,CEITEC, Masaryk University, Brno, Czech Republic
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Zdenek Starek
- International Clinical Research Center, Interventional Cardiac Electrophysiology, St. Anne's University Hospital Brno, Czech Republic.,Department of Cardiovascular Diseases, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Jia K, Jin Q, Liu A, Wu L. Remote magnetic navigation versus manual control navigation for atrial fibrillation ablation: A systematic review and meta-analysis. J Electrocardiol 2019; 55:78-86. [PMID: 31152995 DOI: 10.1016/j.jelectrocard.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/25/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this review was to evaluate the efficacy and safety between remote magnetic navigation (RMN) and manual control navigation (MCN) for atrial fibrillation (AF) ablation. METHODS We searched the PubMed, EMBASE and Cochrane library databases using the key words AF, ablation and magnetic navigation. RESULTS Eighteen studies were identified in this analysis including 4046 patients comparing RMN and MCN in AF ablation, which were all non-randomized controlled studies. No significant difference of AF recurrence rate (40% vs. 38%, OR 1.00, 95% CI 0.82-1.22, p = 0. 97) and acute success rate in achieving pulmonary vein isolation (91% vs. 93%, OR 0.44, 95% CI 0.16-1.17, p = 0.10) was found between RMN and MCN. However, compared with MCN, RMN was associated with significantly lower complication rate (2% vs. 5%, OR 0.44, 95% CI 0.28-0.69, p = 0. 0003) and shorter fluoroscopy time (MD -9.71 min, 95% CI -15.80 to -3.63, p = 0.002). Procedure time (MD 47.05 min, 95% CI 27.5-66.58, p < 0.00001) and ablation time (MD 15.90 min, 95% CI 9.62-22.18, p < 0.00001) of RMN guided AF ablation were significantly longer than those of MCN. CONCLUSION The results of this study suggest that RMN is as effective as MCN in achieving pulmonary vein isolation and freedom from AF recurrence, and has superior safety with less complications and shorter fluoroscopy time.
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Affiliation(s)
- Kangni Jia
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ao Liu
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Dang S, Jons C, Jacobsen PK, Pehrson S, Chen X. Feasibility of a novel mapping system combined with remote magnetic navigation for catheter ablation of premature ventricular contractions. J Arrhythm 2019; 35:244-251. [PMID: 31007789 PMCID: PMC6457387 DOI: 10.1002/joa3.12157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Remote magnetic navigation (RMN) is often used in combination with a 3-dimensional mapping system to perform catheter ablations. This study aim to investigate the feasibility and effectiveness of a novel 3D-mapping system, EnSite Precision, combined with RMN for catheter ablation of premature ventricular contractions (PVCs), and compared it to the procedures performed by CARTO3 with RMN. METHODS Forty-three consecutive PVC patients were either ablated with the guidance of EnSite Precision (n = 22) or CARTO (n = 21) navigated by RMN. Procedure-related details, acute and long-term success were assessed. RESULTS Patient characteristics between both the groups were similar (age: 47.1 ± 19.8 vs 47.1 ± 12.7, female: 63.6% vs 57.1%). No significant difference was found in the procedure time (99.5 ± 30.4 vs 92.9 ± 24.8 min, P = 0.436), mapping time (18.6 ± 12.8 vs 15.5 ± 10.2 min, P = 0.390), radiofrequency ablation time (333.4 ± 267.0 vs 469.3 ± 343.1 s, P = 0.154), fluoroscopy time (4.0 ± 1.9 vs 3.8 ± 2.0 min, P = 0.635), and X-ray dose (1.8 ± 1.4 vs 2.0 ± 1.2 Gycm2, P = 0.649) between the two groups. No significant procedural complication occurred in either group. In addition, there was no significant differences regarding the acute success rate (90.9% vs 90.5%, P = 0.961) and long-term success rate (86.4% vs 81.0%, P = 0.631) after 16.2 ± 6.2 months of follow-up between the two groups. CONCLUSIONS RMN combined with EnSite Precision mapping system is effective and safe for catheter ablation of PVCs.
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Affiliation(s)
- Shipeng Dang
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of CardiologyThe Affiliated Wuxi People's Hospital of Nanjing Medical UniversityWuxiChina
| | - Christian Jons
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Peter Karl Jacobsen
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Steen Pehrson
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Xu Chen
- Department of CardiologyThe Heart CentreRigshospitaletCopenhagen University HospitalCopenhagenDenmark
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19
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Zhao XX, Li KL, Wang RX, Zheng J, Liu XY, Dang SP, Yu ZM, Zhang CY, Yang XJ. Comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation catheter ablation using robotic magnetic navigation system. Clin Cardiol 2019; 42:418-424. [PMID: 30652336 PMCID: PMC6712313 DOI: 10.1002/clc.23156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/24/2023] Open
Abstract
Background No data exist on comparisons of efficacy, safety, and recurrence risk factors of paroxysmal and persistent atrial fibrillation (AF) ablation using robotic magnetic navigation system (MNS), respectively. Methods About 151 AF patients were prospectively enrolled and divided into paroxysmal AF group (n = 102) and persistent AF group (n = 49). Circumferential pulmonary vein antrum isolation (CPVI) was performed in all patients. Linear ablation at the left atrial roof and mitral isthmus was performed in patients with persistent AF in addition to CPVI. The procedural time, X‐ray exposure time, acute and long‐term success rates of CPVI, and procedure‐related complications were analyzed. The AF recurrence rates in the two groups were compared during 1 year, and Cox regression was used to analyze the recurrence risk factors. Results The acute success rates of CPVI in the two groups were 98.04% and 97.96%, respectively. There were no significant differences in the procedural time, X‐ray exposure time, and ablation time between the two groups (P > 0.05). No serious complications appeared in either group. The AF ablation success rates were 70.6% and 57.1% for the paroxysmal and persistent groups respectively at 12‐month follow‐up (P = 0.102). AF duration and coronary heart disease prior to ablation were associated with the higher AF recurrence in patients with persistent AF. Conclusion Ablation using MNS is effective and safe both in patients with paroxysmal and persistent AF. AF duration and coronary heart disease prior to ablation are two independent risk factors of AF recurrence in patients with persistent AF postoperatively.
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Affiliation(s)
- Xiao-Xi Zhao
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China.,Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jie Zheng
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiao-Yu Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Shi-Peng Dang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhi-Ming Yu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chang-Ying Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang-Jun Yang
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
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20
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The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation. Cardiol Res Pract 2019; 2018:3096261. [PMID: 30622820 PMCID: PMC6304809 DOI: 10.1155/2018/3096261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Objective The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P < 0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P < 0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P < 0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.
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21
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Hügl B, Findeisen Z. The Use of Innovative Technologies to Guide Cardiac Procedures. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2012.9.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The advantages of intracardiac echocardiography (ICE) include shorter procedure times, reduced radiation exposure and the elimination of the need for general anesthesia. It is also effective in the safe performance of transseptal punctures. These have led to its increasing use in electrophysiology (EP) procedures. The use of ICE provides unrestricted access to the cardiac anatomy and guides interventional cardiac procedures by providing high-quality images of intracardiac structures and devices. As well as their use as imaging in catheter ablation of atrial fibrillation and other arrhythmias, ICE ultrasound catheters may be used in cardiac valve repair and the closure of atrial septal defects (ASDs). Integration of ICE catheters with electroanatomical mapping systems that construct three dimensional (3D) images have further increased the application of the technique. The use of magnetic navigation systems (MNS) have conferred further advantages including reduced exposure to fluoroscopy and increased operator comfort. This article presents four clinical cases and reviews clinical studies of these techniques.
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Affiliation(s)
- Burkhard Hügl
- Marienhaus Klinikum St Elisabeth Klinik, Neuwied, Germany
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22
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Kany S, Saguner AM. [Usefulness of Electroanatomical Mapping in Rhythmology]. PRAXIS 2018; 107:1325-1331. [PMID: 30482115 DOI: 10.1024/1661-8157/a003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Usefulness of Electroanatomical Mapping in Rhythmology Abstract. Atrial fibrillation is the most common arrhythmia and its prevalence is rising. Therapeutic options include drug treatment and interventional catheter ablation via pulmonary vein isolation (PVI). This procedure was associated with long fluoroscopy times which carried risks for patients and physicians. Electroanatomical mapping (EAM) is a tool to visualize anatomy, voltage and activation of the heart chambers. Current EAM systems used in clinical practice include CARTO®, EnSite NavX® and Rhythmia®. Magnetic fields and impendance approaches are used to create 3D shells of the chambers. The catheter can be used to either collect electrograms or to ablate the target tissue. When using EAM, fluoroscopy time is significantly decreased, and complications can be monitored. Images from CT, MRI or intracardiac echo can be used as a template for creating a map or merged with an existing map to enhance anatomic accuracy.
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Affiliation(s)
- Shinwan Kany
- 1 Klinik für Kardiologie, Universitäres Herzzentrum Zürich
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23
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1392] [Impact Index Per Article: 198.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Lin C, Pehrson S, Jacobsen PK, Chen X. Initial experience of a novel mapping system combined with remote magnetic navigation in the catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2017; 28:1387-1392. [DOI: 10.1111/jce.13332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Changjian Lin
- Department of Cardiology; The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology; Shanghai Rui Jin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Steen Pehrson
- Department of Cardiology; The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology; The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Xu Chen
- Department of Cardiology; The Heart Centre; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Bun SS, Ayari A, Latcu DG, Errahmouni A, Saoudi N. Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use. J Cardiovasc Electrophysiol 2017; 28:745-753. [PMID: 28419605 DOI: 10.1111/jce.13222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/06/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Remote magnetic navigation (RMN) and contact force (CF) sensing catheters are available technologies for radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Our purpose was to compare time to electrogram (EGM) modification suggesting transmural lesions between RMN and CF-guided AF ablation. METHODS AND RESULTS A total of 1,008 RF applications were analyzed in 21 patients undergoing RMN (n = 11) or CF-guided ablation (n = 10) for paroxysmal AF. All procedures were performed in sinus rhythm during general anesthesia. Time to EGM modification was measured until transmurality criteria were fulfilled: (1) complete disappearance of R if initial QR morphology; (2) diminution > 75% of R if initial QRS morphology; (3) complete disappearance of R' of initial RSR' morphology. Impedance drop as well as force time integral (FTI) were also assessed for each application. Mean CF at the beginning of each RF application in the CF group was 11 ± 2 g and mean FTI per application was 488 ± 163 gs. Time to EGM modification was significantly shorter in the RMN group (4.52 ± 0.1 seconds vs. 5.6 ± 0.09 seconds; P < 0.00001). There was no significant difference between other procedural parameters. CONCLUSION Remote magnetic AF ablation is associated with faster EGM modification suggesting transmurality than optimized CF and FTI-guided catheter ablation.
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Affiliation(s)
- Sok-Sithikun Bun
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
| | - Anis Ayari
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
| | | | | | - Nadir Saoudi
- Department of Cardiology, Princess Grace Hospital, Monaco (Principality)
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28
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Da Costa A, Guichard JB, Maillard N, Romeyer-Bouchard C, Gerbay A, Isaaz K. Substantial superiority of Niobe ES over Niobe II system in remote-controlled magnetic pulmonary vein isolation. Int J Cardiol 2017; 230:319-323. [DOI: 10.1016/j.ijcard.2016.12.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/12/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
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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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Yamagata K, Aldhoon B, Kautzner J. Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2016; 5:144-9. [PMID: 27617094 DOI: 10.15420/aer.2016.16.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy. During the procedure, fluoroscopy imaging is still considered essential to visualise catheters in real-time. However, radiation is often ignored by physicians since it is invisible and the long-term risks are underestimated. In this respect, it must be emphasised that radiation exposure has various potentially harmful effects, such as acute skin injury, malignancies and genetic disease, both to patients and physicians. For this reason, every electrophysiologist should be aware of the problem and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AF ablation procedures.
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Affiliation(s)
- Kenichiro Yamagata
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Bashar Aldhoon
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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31
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ROY KARINE, GOMEZ-PULIDO FEDERICO, ERNST SABINE. Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S45-56. [DOI: 10.1111/jce.12903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- KARINE ROY
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - FEDERICO GOMEZ-PULIDO
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - SABINE ERNST
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Research Unit, National Heart and Lung Institute; Imperial College London; London UK
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32
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JIN QI, PEHRSON STEEN, JACOBSEN PETERKARL, CHEN XU. Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation: Experience from 1,006 Procedures. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S23-8. [DOI: 10.1111/jce.12929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- QI JIN
- Department of Cardiology, The Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
- Department of Cardiology, Shanghai Rui Jin Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - STEEN PEHRSON
- Department of Cardiology, The Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - PETER KARL JACOBSEN
- Department of Cardiology, The Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - XU CHEN
- Department of Cardiology, The Heart Centre, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Le VNT, Nguyen NH, Alameh K, Weerasooriya R, Pratten P. Accurate modeling and positioning of a magnetically controlled catheter tip. Med Phys 2016; 43:650-63. [DOI: 10.1118/1.4939228] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Miller AC, Evans AC, Revenaugh J, Weiss JP, Reid BB, Kfoury AG. Combined use of TandemHeart percutaneous ventricular assist device and Stereotaxis magnetic navigation during cardiac ablation procedure. HeartRhythm Case Rep 2015; 2:14-16. [PMID: 28491622 PMCID: PMC5412668 DOI: 10.1016/j.hrcr.2015.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew C Miller
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Annicka C Evans
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - James Revenaugh
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Bruce B Reid
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Abdallah G Kfoury
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
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Wu Y, Li KL, Zheng J, Zhang CY, Liu XY, Cui ZM, Yu ZM, Wang RX, Wang W. Remote magnetic navigation vs. manual navigation for ablation of ventricular tachycardia: a meta-analysis. Neth Heart J 2015. [PMID: 26215291 PMCID: PMC4580670 DOI: 10.1007/s12471-015-0734-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to prospectively evaluate the efficacy and safety of remote magnetic navigation (RMN) in comparison with manual catheter navigation (MCN) in performing ventricular tachycardia ablation. METHODS An electronic search was performed using PubMed (1948-2013) and EMBASE (1974-2013) studies comparing RMN with MCN which were published prior to 31 December 2013. Outcomes of interest were as follows: acute success, recurrence rate, complications, total procedure and fluoroscopic times. Standard mean difference (SMD) and its 95 % confidence interval (CI) were used for continuous outcomes; odds ratios (OR) were reported for dichotomous variables. RESULTS Four non-randomised studies, including a total of 328 patients, were identified. RMN was deployed in 191 patients. Acute success and long-term freedom from arrhythmias were not significantly different between the RMN and control groups (OR 1.845, 95 % CI 0.731-4.659, p = 0.195 and OR 0.676, 95 % CI 0.383-1.194, p = 0.177, respectively). RMN was associated with less peri-procedural complications (OR 0.279, 95 % CI 0.092-0.843, p = 0.024). Shorter procedural and fluoroscopy times were achieved (95 % CI -0.487 to -0.035, p = 0.024 and 95 % CI -1.467 to -0.984, p<0.001, respectively). CONCLUSION The acute and long-term success rates for VT ablation are equal between RMN and MCN, whereas the RMN-guided procedure can be performed with a lower complication rate and less procedural and fluoroscopic times. More prospective randomised trials will be needed to better evaluate the superior role of RMN for catheter ablation of ventricular tachycardia.
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Affiliation(s)
- Y Wu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - K-L Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - J Zheng
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - C-Y Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - X-Y Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - Z-M Cui
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - Z-M Yu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China
| | - R-X Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, 214023, Wuxi, Jiangsu, China.
| | - W Wang
- Wuxi Center for Disease Control and Prevention, 214023, Wuxi, Jiangsu, China
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Bhaskaran A, Chik W, Thomas S, Kovoor P, Thiagalingam A. A review of the safety aspects of radio frequency ablation. IJC HEART & VASCULATURE 2015; 8:147-153. [PMID: 28785694 PMCID: PMC5497290 DOI: 10.1016/j.ijcha.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 12/03/2022]
Abstract
In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT) ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF) and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5-11%, up to 3.4%, up to 1.8% and 4.1-8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.
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Affiliation(s)
- Abhishek Bhaskaran
- Corresponding author at: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, NSW 2145, Australia.
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37
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Impact of catheter ablation with remote magnetic navigation on procedural outcomes in patients with persistent and long-standing persistent atrial fibrillation. J Interv Card Electrophysiol 2015. [DOI: 10.1007/s10840-015-0037-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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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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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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Da Costa A, Levallois M, Romeyer-Bouchard C, Bisch L, Gate-Martinet A, Isaaz K. Remote-controlled magnetic pulmonary vein isolation combined with superior vena cava isolation for paroxysmal atrial fibrillation: A prospective randomized study. Arch Cardiovasc Dis 2015; 108:163-71. [DOI: 10.1016/j.acvd.2014.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 09/25/2014] [Accepted: 10/31/2014] [Indexed: 12/01/2022]
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Plötner P, Harada K, Sugita N, Mitsuishi M. Theoretical analysis of magnetically propelled microrobots in the cardiovascular system. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:870-3. [PMID: 25570097 DOI: 10.1109/embc.2014.6943729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The field of medical microrobotics is rapidly progressing; however, it is particularly challenging to control microrobots inside blood vessels. In this paper, the magnetic propulsion of a microrobot in pulsating flow is investigated. Regarding this task, the advantages of a reduced blood flow velocity are examined. The required magnetic field gradient in relation to the size of the microrobot is theoretically analyzed and compared to that for propulsion during reduced blood flow velocity. Quantitative and qualitative advantages together with the practical challenges are discussed.
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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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BUN SOKSITHIKUN, LATCU DECEBALGABRIEL, ALLOUCHE EMNA, ERRAHMOUNI ABDELKARIM, SAOUDI NADIR. General Anesthesia is Not Superior to Local Anesthesia for Remote Magnetic Ablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:391-7. [DOI: 10.1111/pace.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/18/2014] [Accepted: 09/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- SOK-SITHIKUN BUN
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
| | | | - EMNA ALLOUCHE
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
| | | | - NADIR SAOUDI
- From the Department of Cardiology; Princess Grace Hospital; Monaco (Principality)
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Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev 2014; 3:107-12. [PMID: 26835075 PMCID: PMC4711538 DOI: 10.15420/aer.2014.3.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Ashok Shah
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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Bourke T, Buch E, Mathuria N, Michowitz Y, Yu R, Mandapati R, Shivkumar K, Tung R. Biophysical parameters during radiofrequency catheter ablation of scar-mediated ventricular tachycardia: epicardial and endocardial applications via manual and magnetic navigation. J Cardiovasc Electrophysiol 2014; 25:1165-73. [PMID: 24946895 DOI: 10.1111/jce.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of data on biophysical parameters during radiofrequency ablation of scar-mediated ventricular tachycardia (VT). METHODS AND RESULTS Data were collected from consecutive patients undergoing VT ablation with open-irrigation. Complete data were available for 372 lesions in 21 patients. The frequency of biophysical parameter changes were: >10Ω reduction (80%), bipolar EGM reduction (69%), while loss of capture was uncommon (32%). Unipolar injury current was seen in 72% of radiofrequency applications. Both EGM reduction and impedance drop were seen in 57% and a change in all 3 parameters was seen in only 20% of lesions. Late potentials were eliminated in 33%, reduced/modified in 56%, and remained after ablation in 11%. Epicardial lesions exhibited an impedance drop (90% vs. 76%, P = 0.002) and loss of capture (46% vs. 27%, P < 0.001) more frequently than endocardial lesions. Lesions delivered manually exhibited a >10Ω impedance drop (83% vs. 71%, P = 0.02) and an EGM reduction (71% vs. 40%, P < 0.001) more frequently than lesions applied using magnetic navigation, although loss of capture, elimination of LPs, and a change in all 3 parameters were similarly observed. CONCLUSIONS VT ablation is inefficient as the majority of radiofrequency lesions do not achieve more than one targeted biophysical parameter. Only one-third of RF applications targeted at LPs result in complete elimination. Epicardial ablation within scar may be more effective than endocardial lesions, and lesions applied manually may be more effective than lesions applied using magnetic navigation. New technologies directed at identifying and optimizing ablation effectiveness in scar are clinically warranted.
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Affiliation(s)
- Tara Bourke
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Vollmann D, Lüthje L, Seegers J, Sohns C, Sossalla S, Sohns J, Röver C, Hasenfuß G, Zabel M. Remote magnetic navigation for circumferential pulmonary vein ablation: single-catheter technique or additional use of a circular mapping catheter? J Interv Card Electrophysiol 2014; 41:65-73. [DOI: 10.1007/s10840-014-9912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
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Shurrab M, Danon A, Crystal A, Arouny B, Tiong I, Lashevsky I, Newman D, Crystal E. Remote magnetic navigation for catheter ablation of atrioventricular nodal reentrant tachycardia: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2014; 11:829-36. [PMID: 23895026 DOI: 10.1586/14779072.2013.811968] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation has become a well-established, first-line therapy for atrioventricular nodal reentrant tachycardia (AVNRT), the most common reentry supraventricular tachycardia in humans. Robotic systems are becoming increasingly common in both complex and simple ablation procedures with presumed potential improvements in procedural efficacy and safety. The authors of this article conducted a systematic review and meta-analysis on the effectiveness and safety of the magnetic navigation system (MNS) in comparison with conventional catheter navigation for AVNRT ablation. An electronic search was performed using Cochrane Central database, Medline, Embase and Web of Knowledge between 2002 and 2012. References were searched manually. Outcomes of interest were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. Thirteen studies (seven of which were nonrandomized controlled, four were case series and two were randomized controlled studies) involving 679 adult patients were identified. Twelve studies were based on a single center and one study was multicentral. MNS was deployed in 339 patients. The follow-up period ranged between 75 and 180 days. Acute success and long-term freedom from arrhythmia were not significantly different between MNS and control groups (98 vs 98%, OR: 0.94 [95% CI: 0.21-4.1] and 97 vs 96%, OR: 1.18 [95% CI: 0.35-4.0], respectively). A shorter fluoroscopic time was achieved with MNS; however, this did not reach statistical significance (15 vs 19 min, SDM: -0.26 [95% CI: -0.64-0.12]). Longer total procedure but similar ablation times were noted with MNS (160 vs 148 min, SDM: 3.48 [95% CI: 0.75-6.21] and 4 vs 6 min, SDM: -0.83 [95% CI: -2.19-0.53], respectively). The overall complication rate was similar between both groups (2.7 vs 1.0%, OR: 1.28 [95% CI: 0.33-4.96]). Our data suggest that the usage of MNS results in similar rates of success and complications when compared with conventional manual catheter ablation for AVNRT. MNS had a trend for reduced fluoroscopic time. Longer total procedure time was observed with MNS while the actual ablation time remained similar. Prospective randomized trials will be needed to better evaluate the relative role of MNS for catheter ablation of AVNRT.
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Affiliation(s)
- Mohammed Shurrab
- Arrhythmia Services, Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
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Datino T, Arenal A, Pelliza M, Hernández-Hernández J, Atienza F, González-Torrecilla E, Avila P, Bravo L, Fernández-Avilés F. Comparison of the safety and feasibility of arrhythmia ablation using the Amigo Robotic Remote Catheter System versus manual ablation. Am J Cardiol 2014; 113:827-31. [PMID: 24440330 DOI: 10.1016/j.amjcard.2013.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/16/2022]
Abstract
The aim of this study is to evaluate the safety and feasibility of using the Amigo Remote Catheter System (RCS) in arrhythmia ablation procedures. Because Amigo allows the physician to operate all catheter function outside of the radiation field, operator exposure time was also evaluated. This is a nonrandomized, prospective clinical trial conducted at 1 site (identifier: NCT01834872). The study prospectively enrolled 50 consecutive patients (mean age 59 ± 15 years, 72% men) with any type of arrhythmia (23 atrial fibrillation ablation, 12 common atrial flutters, 10 patients with other supraventricular tachycardia, 4 ventricular tachycardia, and 1 patient with palpitations with no arrhythmia induced) referred for catheter ablation, in which we used RCS. Fifty matched ablation procedures (mean age 57 ± 14 years, 70% men) performed during the same time period, without RCS, were enrolled into the control group. Acute ablation success was 96% with RCS and 98% in the manual group. In only 2 cases, the physician switched to manual ablation (1 ventricular tachycardia and 1 accessory pathway) to complete the procedure. There were no complications related to the use of RCS. No differences were observed in total procedure time, total fluoroscopy time, or total radiofrequency delivery compared with the manual group. In procedures performed with RCS, the operator's fluoroscopy exposure time was reduced by 68 ± 16%. In conclusion, arrhythmia ablation with RCS is safe and feasible. Furthermore, it significantly reduces operator's exposure to radiation.
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Affiliation(s)
- Tomás Datino
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Angel Arenal
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mauricio Pelliza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pablo Avila
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Loreto Bravo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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