Remote Robotic Navigation and Electroanatomical Mapping for Ablation of Atrial Fibrillation

Abstract

Background-Radiofrequency current ablation of atrial fibrillation (AF) requires high technical skills to achieve optimal catheter stability and is associated with an individually high x-ray exposure to both the patient and the operator. To facilitate catheter navigation and to reduce the operator's x-ray burden, remote navigation (RN) systems have been developed. Considerations for navigation of a novel remote robotic navigation system in pulmonary vein isolation (PVI) procedures are reported. Methods and Results-In 65 patients with drug-refractory AF (43 paroxysmal, 22 persistent), complete circumferential PVI was performed using RN in conjunction with different electroanatomic mapping systems. Acute complete PVI using exclusively RN was achieved in 95%. The procedure time was 195Ϯ40 minutes. The operator's x-ray exposure time was reduced by 6Ϯ4 minutes (35%) using RN. In 7 of 14 patients with persistent AF, conversion to sinus rhythm was achieved by radiofrequency current ablation. During a median follow-up period of 239 days (range, 184 to 314 days), 47 of 65 patients (73%) remained free of any documented atrial tachyarrhythmia recurrences after a single procedure. The relative proportion of patients remaining free of AF was 76% and 68% for paroxysmal and persistent AF, respectively. Conclusions-PVI using the novel RN system can be performed safely and effectively. One third of the operator's fluoroscopy exposure time might be saved using RN. However, the questions of whether the overall fluoroscopy exposure is reduced by RN and whether RN improves PVI procedures needs to be assessed during a comparative trial between man and machine. (Circ Arrhythmia Electrophysiol. 2009;2:120-128.)

Incidence and Long-Term Follow-Up of Silent Cerebral Lesions After Pulmonary Vein Isolation Using a Remote Robotic Navigation System as Compared With Manual Ablation

“…Using robotic navigation may affect the risk for SCL for the following reasons: a larger sheath (14F) is advanced into the LA, 8 additional flushing of the inner and outer robotic sheath is required, 19,20 and the tip-to-tissue contact may be enhanced using robotic navigation, thereby potentially increasing the risk of charring, thrombus formation, or gaseous steam formation caused by tissue overheating. 13,15,16 Tissue overheating causing increased steam formation might be 1 of the major reasons why irrigated catheters still produce SCL as irrigation cools the catheter tip but not the tissue.…”

Remote-Controlled Magnetic Pulmonary Vein Isolation Using a New Irrigated-Tip Catheter in Patients With Atrial Fibrillation

“…6,15,16 This is of particular importance since interventional electrophysiologists accumulate a significant amount of radiation exposure throughout their professional careers.…”

The Future of Pulmonary Vein Isolation – Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation?

“…Special catheters with magnets affixed to their distal end can be navigated PV isolation reports in paroxysmal and persistent AF patients using the Sensei system have consistently shown significant shortening of the fluoroscopy time. [48][49][50][51][52] Remote isolation of the PV showed similar midterm follow-up (six-months to one-year) free of atrial arrhythmias to manual point-by-point radiofrequency delivery. Without adjunctive antiarrhythmic drugs ≈70 % of paroxysmal AF patients remained free of atrial arrhythmias.…”

“…Without adjunctive antiarrhythmic drugs ≈70 % of paroxysmal AF patients remained free of atrial arrhythmias. [50][51][52] Initial reports using the Sensei system had raised the concern of higher rate of cardiac tamponade than conventional manual RF delivery 53 , which might be related to remote manipulation of the stiff steerable Artisan catheter (Hansen Medical, Mountain View, CA, US). Further experience and introduction of a special feature of the system to indirectly estimate catheter contact force on the tissue (IntelliSense) have shown that tamponade rates are not greater than the conventional manual approach and may be more related to different temperature and power RF settings.…”