Robotic catheter ablation of left ventricular tachycardia: initial experience

Abstract

Objectives To test the technical feasibility of robotic catheter ablation of left ventricular (LV) tachycardia (VT) using the Hansen Sensei® Robotic system (HRS). Background Catheter ablation of VT can be technically challenging due to difficulty with catheter positioning in the LV and achieving stable contact. The HRS has been used in atrial fibrillation but its utility in VT is unclear. Methods Twenty-three patients underwent LV VT mapping and ablation with the HRS via a trans-septal, trans-mitral valve approach. Nineteen patients underwent substrate mapping and ablation (18 had ischemic cardiomyopathy, one had an apical variant of hypertrophic cardiomyopathy). Four patients had focal VT requiring LV VT mapping and ablation. Procedural endpoints included substrate modification by endocardial scar border ablation and elimination of late potentials, or elimination of inducible focal VT. Results Mapping and ablation were entirely robotic without requiring manual catheter manipulation in all patients and reaching all LV regions with stable contact. Fluoroscopy time of the LV procedure was 22.2 ± 11.2 minutes. Radiofrequency time was 33 ± 21 minutes. Total procedure times were 231 ± 76 minutes. Complications included a left groin hematoma (opposite to the HRS sheath), 1 pericardial effusion without tamponade that was drained successfully, and transient right ventricular failure in a patient with previous left ventricular assist device. At 13.4 ± 6.7 months of follow-up (range 1–19 months), recurrence of VT occurred in 3/23 patients. Conclusions Our initial experience suggests that the HRS allows successful mapping and ablation of LV VT.

Robotic technology in cardiovascular medicine

“…6 The Hansen Sensei® system has also been used to treat ventricular tachycardia in a limited number of patients, with acceptable success rates and low complication rates. 7 Another robotic system widely used in electrophysiology is the remote magnetic navigation system. The system comprises two strong magnets that direct an ablation catheter with a magnetic tip.…”

EHRA/HRS/APHRS expert consensus on ventricular arrhythmias

“…Although LVADs provide haemodynamic support during VAs, patients may experience palpitations, dyspnoea, and right heart failure. Post-operative VT and VF in LVAD recipients tend to be refractory to AAD therapy and may require catheter ablation [230,237,[243][244][245][246][247]. Since many forms of VT in patients with non-ischaemic dilated cardiomyopathy have critical zones of reentrant circuits in the subepicardial myocardium, the postoperative pericardial scarring produced by LVAD implantation renders post-operative epicardial access for ablation very difficult.…”

Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches

“…There are limited data on the use of Sensei robotic ablation of VA. One case series of 23 patients undergoing VT ablation with the system that showed 100% acute success rates with 87% long term freedom from recurrent arrhythmia 10 …”

“…The Sensei robotic Navigation System by Hansen was introduced in 2007 and was employed for catheter ablation of atrial fibrillation (AF) 9 and ventricular arrhythmias 10 . In 2016, Hansen Medical merged with Auris Surgical Robotics.…”

“…There are limited data on the use of Sensei robotic ablation of VA. One case series of 23 patients undergoing VT ablation with the system that showed 100% acute success rates with 87% long term freedom from recurrent arrhythmia. 10 In summary, the Hansen Sensei ablation system appeared to achieve comparable procedural success and complication rates with AF ablation and possibly VA ablation as with manual ablation but was found in several studies to be associated with longer procedure times. While this technology did hold some promise for operator fatigue, which could translate to clinically relevant outcomes, the discontinuation of this system in the market has eliminated any further study of the system.…”