Bipolar ablation: first in man using combined robotic magnetic navigation with a manual approach in a complex pvc case

Abstract

Funding Acknowledgements Type of funding sources: None. Background Standard unipolar catheter ablation (UPA) with radiofrequency for ventricular arrhythmias has reportedly recurrence rates due to a lack of efficient lesions in the deep myocardial substrates to disrupt the critical components of the arrhythmia circuit. First in-vivo bipolar catheter ablations (BPA) show promising results to counter this issue. Precise handling of two catheters simultaneously during BPA is a challenge that the utilization of a robotic magnetic navigation (RMN) system could make safer by robotically controlling one of the catheters. Method A RMN ablation catheter with a 3.5 mm irrigated tip (RMN Navistar Thermocool, Biosense Webster), as an active catheter, as well as an indifferent manual catheter 3.5 mm irrigated non-nav ablation catheter (Celsius Thermocool, Biosense Webster) was connected to a BPA-certified generator system (HAT 500® system (OSYPKA, Germany)). The RMN catheter was controlled by a RMN Stereotaxis- system. A 3D Carto system combined with a VIVO system was used to find the right localization. Results 70-year-old male with ischemic CMP, EF nearly 40%, revascularized through CABG, presented after 4 attempts of ablation of very frequent symptomatic monomorphic PVCs (more than 30000 /24h), with different approaches in different hospitals. The origin of PVCs was mid-septal RV/LV. After LAT Mapping in a transseptal approach with the RMN Catheter (LV), the manual catheter was placed at the opposite site in the RV. Bipolar Ablation was done at 30W (3 min) with acute suppression of the PVCs. The follow-up duration was 6-months with still lasting good result. No complications occurred. Conclusions BPA ablation is an additional energy option in difficult cases. With a RMN system is it feasible and safe. The robotic control of one of the two ablation catheters provides a precise and stable execution of the BPA since the operator only needs to control the second catheter manually while the magnetic field holds the first in place. It therefore also allows a single operator approach.