Remote Navigation for Ablation Procedures – A New Step Forward in the Treatment of Cardiac Arrhythmias

Abstract

Catheter ablation has become the curative treatment for various cardiac arrhythmias, including ventricular tachycardia and atrial fibrillation, leading to more challenging procedures, prolonged fluoroscopy exposure and the need for stable and reproducible catheter movement. In the last decade, remotely-controlled catheter ablation has emerged as a novel concept to improve catheter manoeuvrability and stability. This has the potential to increase procedural success, decrease procedure time and minimise catheter-related complications. To date, two remote navigation systems (Niobe from Stereotaxis and Sensei from Hansen Medical) are commercially available based on magnetic and mechanical driven forces, respectively. Both have shown promise but also shortcomings during clinical evaluation. Recently, two new systems, CGCIMaxwell from Magnetecs and Amigo from Catheter Robotics, have shown promising results in animals. They are under clinical evaluation and are also based on magnetic and mechanical driven forces, respectively. This article describes the basic principles of the systems, summarises their respective published experiences during mapping and ablation procedures, their current clinical applications and future directions.

Robotic Ablation of Atrial Fibrillation

“…It has been discussed before, that manual catheter control may result in inaccurate catheter movements 5,7 . It therefore is of clinical interest, if ablation with the use of a robotic arm is feasible and effective.…”

“…Among others, robotic systems are of special interest. The advantages and principles of robotic ablation have been discussed before [5][6][7] . These systems may not only improve catheter stability by minimizing artefacts of manual catheter manipulation, but also have the advantage of reduced fluoroscopy exposure for the operator since the system is operated via remote control from outside the radiation field.…”

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

“…The system may potentially overcome some of the limitations of the former magnetic-based Niobe system. 10 Thus, endocardial contact force and navigation inside the cardiac chambers may substantially improve by increasing the strength of the magnetic field magnitude up to 0.16 Tesla compared with 0.08 Tesla in the Niobe system. Continuous and rapid shaping and reshaping of the magnetic field, rather than moving external magnets to change the magnetic field, 13,14 provides instantaneously transmitted changes to the tip of the magnetized catheter leading to almost real#time remote navigation.…”

“…New remote navigation systems have been recently developed with the objective of overcoming such limitations and allowing the operators to be away from the X-ray source while they are moving the catheters inside the cardiovascular system. [9][10][11] Two remote navigation systems are currently commercially available; the robotic catheter control system (Sensei system, Hansen Medical) 12 and the magnetic catheter navigation system (Niobe system, Stereotaxis). 13,14 The former is based on two steerable sheaths, through which any conventional catheter can be introduced for further manipulation via a pull-wire mechanism by a robotic arm fixed at a standard fluoroscopy table.…”

Three-Dimensional Passivity-Based Dynamic Control for Tendon-Driven Catheters

“…The Sensei® allows the navigation of the catheter through the teleoperating workstation, but the platform is required to be placed close to catheterization system; therefore, it alleviates the exposure to ionizing radiation partially [1,2]. The Niobe® is controlled remotely with two permanent magnets located on both sides of the patient's bed.…”