1
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DeBuys C, Ghesu FC, Jayender J, Langari R, Kim YH. Separable Tendon-Driven Robotic Manipulator with a Long, Flexible, Passive Proximal Section. JOURNAL OF MECHANISMS AND ROBOTICS 2023; 15:061019. [PMID: 38328596 PMCID: PMC10845131 DOI: 10.1115/1.4062354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
This work tackles practical issues which arise when using a tendon-driven robotic manipulator (TDRM) with a long, flexible, passive proximal section in medical applications. Tendon-driven devices are preferred in medicine for their improved outcomes via minimally invasive procedures, but TDRMs come with unique challenges such as sterilization and reuse, simultaneous control of tendons, hysteresis in the tendon-sheath mechanism, and unmodeled effects of the proximal section shape. A separable TDRM which overcomes difficulties in actuation and sterilization is introduced, in which the body containing the electronics is reusable and the remainder is disposable. An open-loop redundant controller which resolves the redundancy in the kinematics is developed. Simple linear hysteresis compensation and re-tension compensation based on the physical properties of the device are proposed. The controller and compensation methods are evaluated on a testbed for a straight proximal section, a curved proximal section at various static angles, and a proximal section which dynamically changes angles; and overall, distal tip error was reduced.
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Affiliation(s)
- Christian DeBuys
- Texas A&M University, Mechanical Engineering, College Station, TX, USA
| | - Florin C Ghesu
- Siemens Healthineersm, Digital Technology & Innovation, Princeton, NJ, USA
| | - Jagadeesan Jayender
- Surgical Planning Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Reza Langari
- Texas A&M University, Mechanical Engineering, College Station, TX, USA
| | - Young-Ho Kim
- Siemens Healthineers, Digital Technology & Innovation, Princeton, NJ, USA
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2
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Koulaouzidis G, Charisopoulou D, Bomba P, Stachura J, Gasior P, Harpula J, Zarifis J, Marlicz W, Hudziak D, Jadczyk T. Robotic-Assisted Solutions for Invasive Cardiology, Cardiac Surgery and Routine On-Ward Tasks: A Narrative Review. J Cardiovasc Dev Dis 2023; 10:399. [PMID: 37754828 PMCID: PMC10532157 DOI: 10.3390/jcdd10090399] [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: 06/28/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Robots are defined as programmable machines that can perform specified tasks. Medical robots are emerging solutions in the field of cardiology leveraging recent technological innovations of control systems, sensors, actuators, and imaging modalities. Robotic platforms are successfully applied for percutaneous coronary intervention, invasive cardiac electrophysiology procedures as well as surgical operations including minimally invasive aortic and mitral valve repair, coronary artery bypass procedures, and structural heart diseases. Furthermore, machines are used as staff-assisting tools to support nurses with repetitive clinical duties i.e., food delivery. High precision and resolution allow for excellent maneuverability, enabling the performance of medical procedures in challenging anatomies that are difficult or impossible using conventional approaches. Moreover, robot-assisted techniques protect operators from occupational hazards, reducing exposure to ionizing radiation, and limiting risk of orthopedic injuries. Novel automatic systems provide advantages for patients, ensuring device stability with optimized utilization of fluoroscopy. The acceptance of robotic technology among healthcare providers as well as patients paves the way for widespread clinical application in the field of cardiovascular medicine. However, incorporation of robotic systems is associated with some disadvantages including high costs of installation and expensive disposable instrumentations, the need for large operating room space, and the necessity of dedicated training for operators due to the challenging learning curve of robotic-assisted interventional systems.
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Affiliation(s)
- George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Dafni Charisopoulou
- Pediatric Cardiology Department, Great Ormond Street Hospital, London WC1N 3JH, UK;
| | | | | | - Pawel Gasior
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - Jan Harpula
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
| | - John Zarifis
- Cardiology Department, George Papanikolaou General Hospital, 570 10 Thessaloniki, Greece;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-455 Szczecin, Poland;
| | - Damian Hudziak
- Department of Cardiac Surgery, Upper-Silesian Heart Center, 40-635 Katowice, Poland;
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (P.G.); (J.H.)
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic
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3
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Duan W, Akinyemi T, Du W, Ma J, Chen X, Wang F, Omisore O, Luo J, Wang H, Wang L. Technical and Clinical Progress on Robot-Assisted Endovascular Interventions: A Review. MICROMACHINES 2023; 14:197. [PMID: 36677258 PMCID: PMC9864595 DOI: 10.3390/mi14010197] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Prior methods of patient care have changed in recent years due to the availability of minimally invasive surgical platforms for endovascular interventions. These platforms have demonstrated the ability to improve patients' vascular intervention outcomes, and global morbidities and mortalities from vascular disease are decreasing. Nonetheless, there are still concerns about the long-term effects of exposing interventionalists and patients to the operational hazards in the cath lab, and the perioperative risks that patients undergo. For these reasons, robot-assisted vascular interventions were developed to provide interventionalists with the ability to perform minimally invasive procedures with improved surgical workflow. We conducted a thorough literature search and presented a review of 130 studies published within the last 20 years that focused on robot-assisted endovascular interventions and are closely related to the current gains and obstacles of vascular interventional robots published up to 2022. We assessed both the research-based prototypes and commercial products, with an emphasis on their technical characteristics and application domains. Furthermore, we outlined how the robotic platforms enhanced both surgeons' and patients' perioperative experiences of robot-assisted vascular interventions. Finally, we summarized our findings and proposed three key milestones that could improve the development of the next-generation vascular interventional robots.
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Affiliation(s)
- Wenke Duan
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Toluwanimi Akinyemi
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wenjing Du
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Jun Ma
- Shenzhen Raysight Intelligent Medical Technology Co., Ltd., Shenzhen 518063, China
| | - Xingyu Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Fuhao Wang
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Olatunji Omisore
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Shenzhen Engineering Laboratory for Diagnosis & Treatment Key Technologies of Interventional Surgical Robots, Shenzhen 518055, China
| | - Jingjing Luo
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Hongbo Wang
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Lei Wang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Shenzhen Engineering Laboratory for Diagnosis & Treatment Key Technologies of Interventional Surgical Robots, Shenzhen 518055, China
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4
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Lee DH, Kim YH, Collins J, Kapoor A, Kwon DS, Mansi T. Non-Linear Hysteresis Compensation of a Tendon-Sheath-Driven Robotic Manipulator Using Motor Current. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3057043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Animal Experiment of a Novel Neurointerventional Surgical Robotic System with Master-Slave Mode. Appl Bionics Biomech 2021; 2021:8836268. [PMID: 33574888 PMCID: PMC7864736 DOI: 10.1155/2021/8836268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/29/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
In order to inspect and improve the system performance of the neuro-interventional surgical robot and its effectiveness and safety in clinical applications, we conducted ten animal experiments using this robotic system. Cerebral angiography was performed on ten experimental animals, and various mechanical performance indicators, operating time, X-ray radiation dosage to the experimental animals and the experimenter, and arterial damage in the experimental animals were recorded when the robotic system completed cerebral angiography. The results show that the robotic system can successfully complete the cerebral angiography surgery, and the mechanical performance is up to standard. The operating time is almost the same as the physician's operating time. And the mean X-ray radiation dosage received by the experimental animals and experimenter was 0.893 Gy and 0.0859 mSv, respectively. There were no complications associated with damage to the vascular endothelium. The robotic system can basically complete the relevant assessment indicators, and its system performance, effectiveness, and safety in clinical applications meet the standards, basically meeting the requirements of clinical applications of neurointerventional surgery.
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6
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Singh-Moon RP, Yao X, Iyer V, Marboe C, Whang W, Hendon CP. Real-time optical spectroscopic monitoring of nonirrigated lesion progression within atrial and ventricular tissues. JOURNAL OF BIOPHOTONICS 2019; 12:e201800144. [PMID: 30058239 PMCID: PMC6353711 DOI: 10.1002/jbio.201800144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 05/24/2023]
Abstract
Despite considerable advances in guidance of radiofrequency ablation (RFA) therapy for the treatment of cardiac arrhythmias, success rates have been hampered by a lack of tools for precise intraoperative evaluation of lesion extent. Near-infrared spectroscopic (NIRS) techniques are sensitive to tissue structural and biomolecular properties, characteristics that are directly altered by radiofrequency (RF) treatment. In this work, a combined NIRS-RFA catheter is developed for real-time monitoring of tissue reflectance during RF energy delivery. An algorithm is proposed for processing NIR spectra to approximate nonirrigated lesion depth in both atrial and ventricular tissues. The probe optical geometry was designed to bias measurement influence toward absorption enabling enhanced sensitivity to changes in tissue composition. A set of parameters termed "lesion optical indices" are defined encapsulating spectral differences between ablated and unablated tissue. Utilizing these features, a model for real-time tissue spectra classification and lesion size estimation is presented. Experimental validation conducted within freshly excised porcine cardiac specimens showed strong concordance between algorithm estimates and post-hoc tissue assessment.
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Affiliation(s)
- Rajinder P. Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
| | - Xinwen Yao
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
| | - Vivek Iyer
- Department of Medicine, Cardiology Division, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
| | - Charles Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
| | - William Whang
- Department of Medicine, Cardiology Division, Columbia University Medical Center, 630 W. 168 St, New York, NY 10032, USA
- Currently with Department of Medicine, Cardiology Division, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, 500 W. 120 St, New York, NY 10027, USA
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7
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Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Initial Clinical Trial of Robot of Endovascular Treatment with Force Feedback and Cooperating of Catheter and Guidewire. Appl Bionics Biomech 2018; 2018:9735979. [PMID: 29849763 PMCID: PMC5926525 DOI: 10.1155/2018/9735979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/15/2018] [Indexed: 11/17/2022] Open
Abstract
To evaluate the feasibility and safety of the robot of endovascular treatment (RobEnt) in clinical practice, we carried out a cerebral angiography using this robot system. We evaluated the performance of application of the robot system to clinical practice through using this robotic system to perform the digital subtraction angiography for a patient who was suspected of suffering intracranial aneurysm. At the same time, through comparing the postoperative head nuclear magnetic and blood routine with the preoperative examination, we evaluated the safety of application of the robot system to clinical practice. We performed the robot system to complete the bilateral carotid artery and bilateral vertebral arteriography. The results indicate that there was no obvious abnormality in the patient's cerebral artery. No obvious abnormality was observed in the examination of patients' check-up, head nuclear magnetism, and blood routine after the digital subtraction angiography. From this clinical trial, it can be observed that the robot system can perform the operation of cerebral angiography. The robot system can basically complete the related observation indexes, and its accuracy, effectiveness, stability, and safety basically meet the requirements of clinical application in neurointerventional surgery.
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9
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Lindsay BD. The Value Proposition of Remote Catheter Navigation: Efficient Tools Versus Expensive Toys. JACC Clin Electrophysiol 2018; 3:884-886. [PMID: 29759786 DOI: 10.1016/j.jacep.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Bruce D Lindsay
- Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio.
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10
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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: 708] [Impact Index Per Article: 118.0] [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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11
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Rassweiler J, Fiedler M, Charalampogiannis N, Kabakci AS, Saglam R, Klein JT. Robot-assisted flexible ureteroscopy: an update. Urolithiasis 2017; 46:69-77. [PMID: 29170856 DOI: 10.1007/s00240-017-1024-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/11/2017] [Indexed: 12/21/2022]
Abstract
The role of flexible ureteroscopy (FURS) in the management of nephrolithiasis has increased due to the improved armamentarium. However, FURS still represents a challenging technique limiting its diffusion. Similar to previous experiences in laparoscopy, recently developed robotic devices may significantly compensate for the ergonomic deficiencies of FURS. Based on a short description of the history of robotic devices for laparoscopy, this article summarizes all current developments of robotic FURS. In 2008, robotic FURS was first reported using the Sensei-Magellan system designed for interventional cardiology. However, with this device the ureteroscope was only passively manipulated, which represented the main reason why this project has been discontinued after 18 clinical cases. Avicenna Roboflex™ was especially developed for FURS. It consists of a surgeon's console and manipulator of a flexible ureterorenoscope. The console provides an adjustable seat with armrests and two manipulators of the endoscope: the right wheel enables deflection and the left horizontal joystick allows rotation as well as advancing and retracting the instrument. The speed of rotation and advancement can be regulated at the screen of the console. Using the IDEAL system for evaluation of new robotic devices, safety and efficacy of the system could be demonstrated in two multi-centric studies providing significant improved ergonomics for the surgeon (IDEAL stage 1 and 2). Future studies are necessary to determine the final role of robotic FURS.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, 74078, Heilbronn, Germany.
| | - Marcel Fiedler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, 74078, Heilbronn, Germany
| | - Nikos Charalampogiannis
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, 74078, Heilbronn, Germany
| | | | - Remzi Saglam
- Department of Urology, Medicana International Hospital, Ankara, Turkey
| | - Jan-Thorsten Klein
- Department of Urology, Medical School Ulm, University of Ulm, Ulm, Germany
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12
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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: 1370] [Impact Index Per Article: 195.7] [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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13
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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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14
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Maor E, Eleid MF, Gulati R, Lerman A, Sandhu GS. Current and Future Use of Robotic Devices to Perform Percutaneous Coronary Interventions: A Review. J Am Heart Assoc 2017; 6:e006239. [PMID: 28739860 PMCID: PMC5586317 DOI: 10.1161/jaha.117.006239] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elad Maor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Abstract
Several remote catheter navigation systems have been developed and are now commercially available. However, these systems typically require specialized catheters or equipment, as well as time-consuming operations for the system set-up. In this paper, we present CathROB, a highly compact and versatile robotic system for remote navigation of standard tip-steerable electrophysiology (EP) catheters. Key features of CathROB include an extremely compact design that minimizes encumbrance and time for system set-up in a standard cath lab, a force-sensing mechanism, an intuitive command interface, and functions for automatic catheter navigation and repositioning. We report in vitro and in vivo animal evaluation of CathROB. In vitro results showed good accuracy in remote catheter navigation and automatic repositioning (1.5 ± 0.6 mm for the left-side targets, 1.7 ± 0.4 mm for the right-side targets). Adequate tissue contact was achieved with remote navigation in vivo. There were no adverse events, including absence of cardiac perforation or cardiac damage, indicative of the safety profile of CathROB. Although further preclinical and clinical studies are required, the presented CathROB system seems to be a promising solution for an affordable and easy-to-use remote catheter navigation.
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16
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Rafii-Tari H, Riga CV, Payne CJ, Hamady MS, Cheshire NJ, Bicknell CD, Yang GZ. Reducing contact forces in the arch and supra-aortic vessels using the Magellan robot. J Vasc Surg 2016; 64:1422-1432. [DOI: 10.1016/j.jvs.2015.06.215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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17
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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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18
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Rodríguez-Mañero M, Schurmann P, Valderrábano M. Combination of Hansen Robotic system with cryocatheter in a challenging parahisian accessory pathway ablation. Indian Pacing Electrophysiol J 2016; 15:303-4. [PMID: 27479207 PMCID: PMC4867965 DOI: 10.1016/j.ipej.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A perceived distinctive feature of cryoablation is the stability (cryoadherence) of the catheter tip during cold temperatures at the desired location, even during tachycardia. We report the case report of a young patient with a parahisian accessory pathway where stability of the ablation catheter was not achieved despite using the cryocatheter with a steerable sheath. Ultimately, stability at the desired location was achieved robotically by means of Hansen system (Hansen Medical, Mountain View, CA, USA).
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
| | - Paul Schurmann
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
| | - Miguel Valderrábano
- Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, TX, USA
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19
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Dello Russo A, Fassini G, Conti S, Casella M, Di Monaco A, Russo E, Riva S, Moltrasio M, Tundo F, De Martino G, Gallinghouse GJ, Di Biase L, Natale A, Tondo C. Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study. J Interv Card Electrophysiol 2016; 46:97-103. [DOI: 10.1007/s10840-016-0102-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
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20
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Gerstenfeld EP, Duggirala S. Atrial Fibrillation Ablation: Indications, Emerging Techniques, and Follow-Up. Prog Cardiovasc Dis 2015; 58:202-12. [DOI: 10.1016/j.pcad.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation. Clin Res Cardiol 2015. [PMID: 26199066 DOI: 10.1007/s00392-015-0892-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Long-term results after circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF) using a robotic navigation system (RNS) have not yet been reported. OBJECTIVE To evaluate long-term results of patients with PAF after CPVI using RNS. METHODS In this study, 200 patients (n = 151 (75.5%) male; median age 62.2 (54.7-67.7) years) with PAF were evaluated. In 100 patients, RNS (RN-group) was used for CPVI and compared to 100 manually ablated control patients (MN-group). Radiofrequency was used in conjunction with 3D electroanatomic mapping. Power was limited to 30 watts (W) at the posterior left atrial (LA) wall in the first 49 RNS patients (RN-group-a). After esophageal perforation occurred in one RN-group-a patient, maximum power was reduced to 20 W for the subsequent 51 patients (RN-group-b). RESULTS After a median follow-up of 2 years, single (77/100 vs 77/100, p = 0.89) and multiple (90/100 vs 93/100, p = 0.29) procedure success rates were comparable between RN-group and MN-group. Single procedure success rate was significantly lower in RN-group-a as compared to RN-group-b (65.3 vs 88.2%, p = 0.047). In RN-group-a patients, procedural times [200 (170-230) vs 152 (132-200) minutes, p < 0.01] and fluoroscopy times [16.6 (12.9-21.6) minutes vs 13.7 (9.5-19) minutes, p = 0.043] were significantly longer compared to RN-group-b patients. CONCLUSION Long-term success rate after CPVI using RNS was comparable to manual ablation. Despite a lower power limit of 20 W at the posterior LA wall, single procedure success rate was higher in RN-group-b as compared to RN-group-a. Procedure time and fluoroscopy time decreased, whilst success rate increased with increasing experience in the RN-group.
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22
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Abstract
Catheter ablation of atrial fibrillation (AF) is performed increasingly worldwide and with the development of new technologies the procedures have become safer and more effective after a single attempt, particularly with paroxysmal AF. However, success rates for persistent AF ablation remain far lower than paroxysmal AF and there is large variation in the strategies used worldwide. This review describes the background to persistent AF ablation, the different strategies used and their associated risks and benefits, developing technologies and the authors' perspective on the future of this rapidly evolving area.
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Affiliation(s)
- Kim Rajappan
- Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
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23
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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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24
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Duran C, Estrada S, O'Malley M, Lumsden AB, Bismuth J. Kinematics effectively delineate accomplished users of endovascular robotics with a physical training model. J Vasc Surg 2015; 61:535-41. [DOI: 10.1016/j.jvs.2014.10.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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25
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Arora KS, Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K. Learning curves for cardiothoracic and vascular surgical procedures--a systematic review. Postgrad Med 2014; 127:202-14. [PMID: 25529043 DOI: 10.1080/00325481.2014.996113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this systematic review is to evaluate the learning curve (LC) literature and identify the LC of cardiothoracic and vascular surgical procedures. SUMMARY AND BACKGROUND The LC describes an observation that a learner's performance improves over time during acquisition of new motor skills. Measuring the LC of surgical procedures has important implications for surgical innovation, education, and patient safety. Numerous studies have investigated LCs of isolated operations in cardiothoracic and vascular surgeries, but a lack of uniformity in the methods and variables used to measure LCs has led to a lack of systematic reviews. METHODS The MEDLINE®, EMBASE™, and PsycINFO® databases were systematically searched until July 2013. Articles describing LCs for cardiothoracic and vascular procedures were included. The type of procedure, statistical analysis, number of participants, procedure setting, level of participants, outcomes, and LCs were reviewed. RESULTS A total of 48 studies investigated LCs in cardiothoracic and vascular surgeries. Based on operating time, the LC for coronary artery bypass surgery ranged between 15 and 100 cases; for endoscopic vessel harvesting and other cardiac vessel surgery between 7 and 35 cases; for valvular surgery, which included repair and replacement, between 20 and 135 cases; for video-assisted thoracoscopic surgery, between 15 and 35 cases; for vascular neurosurgical procedures between 100 and 500 cases, based on complications; for endovascular vessel repairs between 5 and 40 cases; and for ablation procedures between 25 and 60 cases. However there was a distinct lack of standardization in the variables/outcome measures used, case selection, prior experience, and supervision of participating surgeons and a range of statistical analyses to compute LCs was noted. CONCLUSION LCs in cardiothoracic and vascular procedures are hugely variable depending on the procedure type, outcome measures, level of prior experience, and methods/statistics used. Uniformity in methods, variables, and statistical analysis is needed to derive meaningful comparisons of LCs. Acknowledgment and application of learning processes other than those reliant on volume-outcomes relationship will benefit LC research and training of surgeons.
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Affiliation(s)
- Karan Singh Arora
- Department of Urology, King's Health Partners, MRC Centre for Transplantation, King's College London, Guy's Hospital , St Thomas Street, London , UK
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26
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Ullah W, McLean A, Hunter RJ, Baker V, Richmond L, Cantor EJ, Dhinoja MB, Sporton S, Earley MJ, Schilling RJ. Randomized trial comparing robotic to manual ablation for atrial fibrillation. Heart Rhythm 2014; 11:1862-9. [DOI: 10.1016/j.hrthm.2014.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Indexed: 11/30/2022]
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Almendral J. First evidence of clinical benefit of robotically driven catheter ablation or an outlayer? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1423-6. [PMID: 25234513 PMCID: PMC4232929 DOI: 10.1111/pace.12509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jesús Almendral
- Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain
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28
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Ullah W, Hunter RJ, Haldar S, McLean A, Dhinoja M, Sporton S, Earley MJ, Lorgat F, Wong T, Schilling RJ. Comparison of robotic and manual persistent AF ablation using catheter contact force sensing: an international multicenter registry study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1427-35. [PMID: 25220575 DOI: 10.1111/pace.12501] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/27/2014] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter-based contact force sensing (CFS) technology gives detailed information regarding contact between the catheter tip and myocardium. This may result in more effective ablation procedures. The primary objective of this study was comparison of remote robotic navigation (RRN) and Manual CFS ablation. The secondary objective was to compare CFS with non-CFS ablation for both navigation modes. METHODS Prospective registries of consecutive cases undergoing their first ablation for persistent atrial fibrillation (AF) from six hospitals in the United Kingdom and South Africa were analyzed: 50 Manual/CFS and 50 RRN/CFS cases were included. Historical control non-CFS ablation patients were matched by propensity score, giving a total 200 patient cohort. RESULTS RRN/CFS was associated with improved single procedure 1-year success rates (64% vs 36%, P = 0.01) and shorter fluoroscopy times (41% reduction, P < 0.0005) than Manual/CFS ablation, without any difference in procedure times (P = 0.8). The mean contact force was higher in RRN/CFS than Manual/CFS cases (16 [15-18 g] vs 13 [12-15 g], respectively, P = 0.003). Compared with non-CFS historical controls, CFS cases had higher 1-year success rates for RRN (64% vs 36%, P = 0.01), but not Manual ablation (36% vs 38%, P = 1). Procedure times were reduced for CFS cases (20%, P < 0.005 both navigation modes), as were fluoroscopy times (Manual: 43%, RRN 83%, P < 0.005 for both). There were no differences in rates of major or minor complications for either comparison (P > 0.5). CONCLUSIONS A combination of RRN and CFS is associated with improved success rates at 1 year and fluoroscopy times for persistent AF ablation, compared with Manual ablation and non-CFS RRN ablation.
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Affiliation(s)
- Waqas Ullah
- Cardiology Research Department, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Haines DE, Beheiry S, Akar JG, Baker JL, Beinborn D, Beshai JF, Brysiewicz N, Chiu-Man C, Collins KK, Dare M, Fetterly K, Fisher JD, Hongo R, Irefin S, Lopez J, Miller JM, Perry JC, Slotwiner DJ, Tomassoni GF, Weiss E. Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety. Heart Rhythm 2014; 11:e9-51. [PMID: 24814989 PMCID: PMC7106221 DOI: 10.1016/j.hrthm.2014.03.042] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
| | - Salwa Beheiry
- California Pacific Medical Center, San Francisco, California
| | - Joseph G. Akar
- Yale University School of Medicine, New Haven Connecticut
| | | | | | | | | | | | | | | | | | | | - Richard Hongo
- Sutter Pacific Medical Foundation, San Francisco, California
| | | | | | - John M. Miller
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - David J. Slotwiner
- Hofstra School of Medicine, North Shore-Long Island Jewish Health System, New Hyde Park, New York
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Zuchowski B, Kaczmarek K, Szumowski L, Li YG, Ptaszynski P. Interventional treatment of atrial fibrillation - contemporary methods and perspectives. Expert Rev Med Devices 2014; 11:595-603. [PMID: 25060723 DOI: 10.1586/17434440.2014.941810] [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: 11/08/2022]
Abstract
Atrial fibrillation (AF) is estimated to affect nearly 3 million people around the world. It is the most common arrhythmia and its incidence increases with age. Catheter ablation is an interventional procedure performed to reduce the patient's AF burden when pharmacotherapy did not succeed in relieving the patient's symptoms. The ablation is most effective in paroxysmal AF; however, many techniques are being developed to make this procedure more eligible for patients with persistent arrhythmia. The most common AF ablation technique involves separating electric activity of the pulmonary veins from the left atrium. Over recent years, many novel and promising techniques were developed (e.g., balloon cryoablation, circular catheter ablation, laser ablation, robotic navigation, etc.), which may further improve AF ablation efficacy.
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Affiliation(s)
- Bartosz Zuchowski
- Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
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31
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Zhang W, Jia N, Su J, Lin J, Peng F, Niu W. The comparison between robotic and manual ablations in the treatment of atrial fibrillation: a systematic review and meta-analysis. PLoS One 2014; 9:e96331. [PMID: 24800808 PMCID: PMC4011747 DOI: 10.1371/journal.pone.0096331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/06/2014] [Indexed: 12/30/2022] Open
Abstract
Objective To examine in what aspects and to what extent robotic ablation is superior over manual ablation, we sought to design a meta-analysis to compare clinical outcomes between the two ablations in the treatment of atrial fibrillation. Methods and Results A literature search was conducted of PubMed and EMBASE databases before December 1, 2013. Data were extracted independently and in duplicate from 8 clinical articles and 792 patients. Effect estimates were expressed as weighted mean difference (WMD) or odds ratio (OR) and the accompanied 95% confidence interval (95% CI). Pooling the results of all qualified trials found significant reductions in fluoroscopic time (minutes) (WMD; 95% CI; P: -8.9; -12.54 to -5.26; <0.0005) and dose-area product (Gy×cm2) (WMD; 95% CI; P: -1065.66; -1714.36 to -416.96; 0.001) for robotic ablation relative to manual ablation, with evident heterogeneity (P<0.0005) and a low probability of publication bias. In subgroup analysis, great improvement of fluoroscopic time in patients with robotic ablation was consistently presented in both randomized and nonrandomized clinical trials, particularly in the former (WMD; 95% CI; P: -12.61; -15.13 to -10.09; <0.0005). Success rate of catheter ablation was relatively higher in patients with robotic ablation than with manual ablation (OR; 95% CI; P: 3.45; 0.24 to 49.0; 0.36), the difference yet exhibiting no statistical significance. Conclusions This study confirmed and extended previous observations by quantifying great reductions of fluoroscopic time and dose-area product in patients referred for robotic ablation than for manual ablation in the treatment of atrial fibrillation, especially in randomized clinical trials.
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Affiliation(s)
- Wenli Zhang
- Department of Cardiology, Fuzhou General Hospital of Nanjing Command, PLA, Fujian Medical University, Fuzhou, Fujian, China
| | - Nan Jia
- Department of Cardiology, The Fourth People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Jinzi Su
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinxiu Lin
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Feng Peng
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- * E-mail: (FP); (WN)
| | - Wenquan Niu
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (FP); (WN)
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Shurrab M, Schilling R, Gang E, Khan EM, Crystal E. Robotics in invasive cardiac electrophysiology. Expert Rev Med Devices 2014; 11:375-81. [DOI: 10.1586/17434440.2014.916207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yoshimitsu K, Kato T, Song SE, Hata N. A novel four-wire-driven robotic catheter for radio-frequency ablation treatment. Int J Comput Assist Radiol Surg 2014; 9:867-74. [PMID: 24510205 DOI: 10.1007/s11548-014-0982-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Robotic catheters have been proposed to increase the efficacy and safety of the radio-frequency ablation treatment. The robotized motion of current robotic catheters mimics the motion of manual ones-namely, deflection in one direction and rotation around the catheter. With the expectation that the higher dexterity may achieve further efficacy and safety of the robotically driven treatment, we prototyped a four-wire-driven robotic catheter with the ability to deflect in two- degree-of-freedom motions in addition to rotation. METHODS A novel quad-directional structure with two wires was designed and developed to attain yaw and pitch motion in the robotic catheter. We performed a mechanical evaluation of the bendability and maneuverability of the robotic catheter and compared it with current manual catheters. RESULTS We found that the four-wire-driven robotic catheter can achieve a pitching angle of 184.7[Formula: see text] at a pulling distance of wire for 11 mm, while the yawing angle was 170.4[Formula: see text] at 11 mm. The robotic catheter could attain the simultaneous two- degree-of-freedom motions in a simulated cardiac chamber. CONCLUSION The results indicate that the four-wire-driven robotic catheter may offer physicians the opportunity to intuitively control a catheter and smoothly approach the focus position that they aim to ablate.
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Affiliation(s)
- Kitaro Yoshimitsu
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, SPL L1-050 ASB1, Boston, MA, USA,
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35
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Wójcik M, Berkowitsch A, Greis H, Zaltsberg S, Hamm CW, Pitschner HF, Kuniss M, Neumann T. Learning Curve in Cryoballoon Ablation of Atrial Fibrillation. Circ J 2014; 78:1612-8. [DOI: 10.1253/circj.cj-13-1253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maciej Wójcik
- Department of Cardiology, Kerckhoff Heart and Thorax Center
- Department of Cardiology, Medical University of Lublin
| | | | - Harald Greis
- Department of Cardiology, Kerckhoff Heart and Thorax Center
| | | | - Christian W. Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center
- Department of Cardiology, Justus-Liebig University of Giessen
| | | | - Malte Kuniss
- Department of Cardiology, Kerckhoff Heart and Thorax Center
| | - Thomas Neumann
- Department of Cardiology, Kerckhoff Heart and Thorax Center
- Department of Cardiology, Justus-Liebig University of Giessen
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Di Biase L, Paoletti Perini A, Mohanty P, Goldenberg AS, Grifoni G, Santangeli P, Santoro F, Sanchez JE, Horton R, Joseph Gallinghouse G, Conti S, Mohanty S, Bailey S, Trivedi C, Garg A, Grogan AP, Wallace DT, Padeletti L, Reddy V, Jais P, Haïssaguerre M, Natale A. Visual, tactile, and contact force feedback: which one is more important for catheter ablation? Results from an in vitro experimental study. Heart Rhythm 2013; 11:506-13. [PMID: 24252284 DOI: 10.1016/j.hrthm.2013.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND During radiofrequency ablation, effective contact is crucial in determining lesions efficacy. OBJECTIVE The purpose of this study was to compare operators' ability to assess contact pressure using visual and tactile feedbacks together or alone in an experimental model. METHODS In a in vitro experimental setup replicating manual catheter manipulation and recording the applied force, evaluators were asked to identify three levels of force (first, ablation, and maximum contact) as the catheter contacted the tissue model using (1) visual feedback only by fluoroscopy, "blinded" to touch; (2) tactile feedback only, blinded to fluoroscopy; and (3) both tactile and visual feedback together. The latter was regarded as reference. The experiment was repeated using a catheter force sensing technology during robotic navigation. RESULTS During manual navigation, tighter association was shown for the visual method than for the tactile method: median difference with reference: first contact -1 (P = .97) vs -2 (P = .90); ablation contact 2 (P = .1) vs -7 (P = .03); maximum contact 2 (P = .06) vs -28 (P = .02). Bland-Altman plot and Deming regression confirmed for the visual method the good agreement with reference and the absence of bias at any level and showed for the tactile higher values and proportional bias that reached statistical significance at ablation and maximum contact. During robotic navigation, agreement was higher for the tactile than for the visual only method. CONCLUSION During manual navigation, visual feedback alone is in better agreement with the reference compared to the tactile only approach. During robotic navigation, agreement is looser for the visual only approach. More objective feedback of contact pressure during ablation procedures is desirable.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | | | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | - Gino Grifoni
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Francesco Santoro
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | - Sergio Conti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Shane Bailey
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | | | | | - Luigi Padeletti
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Vivek Reddy
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York
| | - Pierre Jais
- Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France
| | - Michelle Haïssaguerre
- Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiology, Stanford University, California; Case Western Reserve University, Cleveland, Ohio; EP Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California.
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Cavo-tricuspid isthmus radiofrequency ablation using a novel remote navigation catheter system in patients with typical atrial flutter. Europace 2013; 16:558-62. [DOI: 10.1093/europace/eut285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dewire J, Calkins H. Update on atrial fibrillation catheter ablation technologies and techniques. Nat Rev Cardiol 2013; 10:599-612. [DOI: 10.1038/nrcardio.2013.121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pison L, Proclemer A, Bongiorni MG, Marinskis G, Hernandez-Madrid A, Blomstrom-Lundqvist C. Imaging techniques in electrophysiology and implantable device procedures: results of the European Heart Rhythm Association survey. Europace 2013; 15:1333-6. [DOI: 10.1093/europace/eut259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rillig A, Schmidt B, Feige B, Wissner E, Metzner A, Arya A, Mathew S, Makimoto H, Wohlmuth P, Ouyang F, Kuck KH, Tilz RR. Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome. Clin Res Cardiol 2013; 102:885-93. [PMID: 23896973 DOI: 10.1007/s00392-013-0602-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 07/17/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists. METHODS AND RESULTS In this pilot study, CPVI combined with LAI-ablation were performed using a RNS and 3D-mapping system in 42 patients with persistent (n = 24, 57.1 %) or longstanding persistent AF. Ablation was performed using either a 3.5 mm irrigated tip catheter (ITC) with 6 (group-A, n = 16; max. 40 W, contact force 10-40 g) or (after a steam pop occurred in one patient) with a 4 mm ITC with 12 irrigation holes (group-B, n = 26; max. 30 W, contact force 10-30 g). Epicardial ablation was performed manually whenever bidirectional LAI-block could not be obtained with a maximum of 20 endocardial RF-applications. LAI-conduction block was achieved in all patients using RNS; in six patients (14.3 %), additional epicardial ablation was required to achieve LAI-block. A steam pop occurred during LAI-ablation resulting in cardiac tamponade in one patient in group-A. After a median follow-up period of 21 months, arrhythmia recurrence was seen in in 23/42 patients (18 patients with AF and 5 patients with atrial tachycardia) and repeat procedure was performed in 12 (28.6 %) patients; recovered LAI-conduction was found in 5/12 (41.7 %) patients. The RNS-group was compared to a historical group of 20 patients with manual LAI-ablation. Using RNS, LAI-block was more often achieved (42 (100 %) vs 16 (80 %), p < 0.01) and epicardial ablation was required in a significantly smaller number of patients (6 (14.3) vs 10 (50 %), p < 0.01). CONCLUSIONS LAI-ablation using RNS appears to be feasible in all patients. At repeat procedure, LAI-conduction can frequently occur; power and contact-force adaption appears to be mandatory to reduce the risk of complications. Using RNS, instead of a manual approach for LAI-line ablation may facilitate creation of a bidirectional LAI-block.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany,
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Khan EM, Frumkin W, Ng GA, Neelagaru S, Abi-Samra FM, Lee J, Giudici M, Gohn D, Winkle RA, Sussman J, Knight BP, Berman A, Calkins H. First experience with a novel robotic remote catheter system: Amigo™ mapping trial. J Interv Card Electrophysiol 2013; 37:121-9. [DOI: 10.1007/s10840-013-9791-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
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Moya À, Sancho-Tello MJ, Arenal Á, Fidalgo ML, Brugada R, Martínez Ferrer J, Merino JL, Ruíz Mateas F, Mont JL. Innovations in heart rhythm disturbances: cardiac electrophysiology, arrhythmias, and cardiac pacing. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2013; 66:116-23. [PMID: 24775385 DOI: 10.1016/j.rec.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/03/2012] [Indexed: 11/24/2022]
Abstract
This article reviews the most relevant articles published in 2012 in the field of arrhythmias, on subjects that include clinical arrhythmology, ablation, cardiac pacing, and the genetics of sudden cardiac death.
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Affiliation(s)
- Àngel Moya
- Unidad de Arritmias, Servicio de Cardiología, Universidad Autónoma de Barcelona, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
| | - María José Sancho-Tello
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Arenal
- Unidad de Arritmias, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ramon Brugada
- Centre de Genètica Cardiovascular IDIBGI y Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - José Martínez Ferrer
- Unidad de Arritmias, Servicio de Cardiología, Hospital General de Araba, Vitoria, Álava, Spain
| | - José Luis Merino
- Unidad de Electrofisiología Cardiaca Robotizada, Servicio de Cardiología, Hospital La Paz, Madrid, Spain
| | - Francisco Ruíz Mateas
- Unidad de Estimulación Cardiaca, Servicio de Cardiología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Josep Lluis Mont
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
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Novedades en alteraciones del ritmo cardiaco: electrofisiología cardiaca, arritmias y estimulación cardiaca. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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