Feasibility and Safety of Remote-Controlled Magnetic Navigation for Ablation of Atrial Fibrillation

Katsiyiannis, William T.; Melby, Daniel P.; Matelski, Jayme L.; Ervin, Vanessa L.; Laverence, Kerri L.; Gornick, Charles C.

doi:10.1016/j.amjcard.2008.08.012

Cited by 49 publications

(24 citation statements)

References 11 publications

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“…So far, only limited data are available on the clinical utility of the RMN system for catheter-based PV isolation [5–10]. Early reports used non-irrigated ablation catheters, which limits the comparability to our results [7, 8, 10]. Very recently, first reports on the efficacy of RMN-guided PV isolation with an open-irrigated ablation catheter have been published by single centers [5, 6, 9].…”

Section: Discussionmentioning

confidence: 99%

Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation

et al. 2011

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BackgroundOnly limited data exist on the clinical utility of remote magnetic navigation (RMN) for pulmonary vein (PV) ablation. Aim of this prospective study was to evaluate the safety and efficacy of RMN for PV isolation as compared to the manual (CON) approach.Methods and resultsA total of 161 consecutive patients undergoing circumferential PV isolation were included. Open-irrigated 3.5 mm ablation catheters under the guidance of a mapping system were used. The catheter was navigated with the Stereotaxis Niobe II system in the RMN group (n = 107) and guided manually in the CON group (n = 54). Electrical isolation of all PVs was achieved in 90% of the patients in the RMN group and in 87% in the CON group (p = 0.6). All subjects were followed every 3 months by 7d Holter-ECG. At 12 months of follow-up, 53.5% (RMN) and 55.5% (CON) of the patients were free of any left atrial tachycardia/atrial fibrillation (AF) episode (p = 0.57). Free of symptomatic AF recurrence were 66.3% (RMN) and 62.1% (CON) of the subjects (p = 0.80). Use of RMN was associated with longer procedure duration (p < 0.0001), ablation times (p < 0.0001), and RF current application duration (p < 0.05). In contrast, fluoroscopy time was lower in the RMN group (p < 0.0001). Major complications occurred in 6 of 161 procedures (3.7%), with no significant difference between groups (p = 0.75).ConclusionRMN-guided PV ablation provides comparable acute and long-term success rates as compared to manual navigation. Procedural complication rates are similar. The use of RMN is associated with markedly reduced fluoroscopy time, but prolonged ablation and procedure duration.

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Section: Discussionmentioning

confidence: 99%

Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation

et al. 2011

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“…Currently, systems are being developed to assess and control tissue contact, including robotic [58–61] or magnetic catheter navigations [62–64] and sensors in the catheter tip detecting force [65, 66]. …”

Section: Lesion Formationmentioning

confidence: 99%

Advances in Imaging for Atrial Fibrillation Ablation

D’Silva

Wright

2011

Radiology Research and Practice

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Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electroanatomic mapping systems, preprocedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electrophysiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment.

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“…Despite the low success rate and char formation with the solid-tip catheter, the authors reported enthusiasm about remote magnetic navigation. Katsiyiannis et al 60 reported an 80% success rate with a 1-year follow-up in 20 patients who underwent ablation with the 4-mm solid-tip catheter.…”

Section: Burkhardt and Natale New Technologies In Atrial Fibrillationmentioning

confidence: 99%

New Technologies in Atrial Fibrillation Ablation

Burkhardt

Natale

2009

Circulation

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he treatment of atrial fibrillation has changed greatly in the past decade. Not long ago, the scientific community argued the benefits of a rate-control strategy versus a rhythmcontrol strategy. 1 This argument was always hampered by the relative ineffectiveness of the antiarrhythmic medications used as rhythm-control agents. Ablation therapy for the treatment of atrial fibrillation has quickly evolved. Originally, ablation was focused on finding triggers of atrial fibrillation in the pulmonary veins. 2,3 Now, ablation offers a potential curative strategy for patients with paroxysmal, persistent, or permanent atrial fibrillation. Recent data continue to show that atrial fibrillation ablation is superior to the currently available antiarrhythmic medications in the maintenance of sinus rhythm, and the Food and Drug Administration has approved devices labeled for the ablation of atrial fibrillation. 4 -6 It is estimated that Ͼ2 million people in the United States have atrial fibrillation. 7 Although the number of atrial fibrillation ablations continues to increase year after year, offering this therapy to all potential candidates is impossible because of several limitations. 8,9 A finite number of fellows are being trained in programs that offer a great deal of experience in atrial fibrillation ablation, and there is limited opportunity for practicing electrophysiologists to learn new techniques. Unlike supraventricular tachycardia ablation, atrial fibrillation ablation requires greater technical skill, significantly more lesions, and time. Like many other medical procedures, technological innovation is likely to be a contributing factor in making atrial fibrillation ablation a more commonplace and widely practiced therapy.Navigating the complex anatomy of the left atrium is also difficult to master. Imaging technologies have been used to orient the operator to the anatomy and the location of the ablation catheters in this anatomy. With fluoroscopy alone, it is difficult to determine anterior versus posterior orientation or the presence of the catheter in a pulmonary vein versus the left atrial appendage. Intracardiac echocardiography (ICE) provides 2-dimensional navigation assistance and excellent anatomic detail; however, it is difficult to locate the catheter tip at all times in the echocardiography field. Without 3-dimensional (3D) imaging, navigation with ICE alone is also difficult. Electroanatomic mapping (EAM) systems offer a 3D view and nearly real-time catheter tip localization within a created construct of the left atrium, but the data are heavily dependent on the input of the operator and cartographer. Newer technology has merged these 2 imaging modalities to offer the best of both worlds.Remotely obtained computed tomography (CT) imaging of the left atrium has been performed to define the complex anatomy of the left atrium. This can be integrated into EAMs or imaging systems to aid in navigation and procedure planning. However, conditions at the time of CT may be different from those at the time of a...

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Feasibility and Safety of Remote-Controlled Magnetic Navigation for Ablation of Atrial Fibrillation

Cited by 49 publications

References 11 publications

Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation

Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation

Advances in Imaging for Atrial Fibrillation Ablation

New Technologies in Atrial Fibrillation Ablation

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