Comparison of the Safety and Feasibility of Arrhythmia Ablation Using the Amigo Robotic Remote Catheter System Versus Manual Ablation

Datino, Tomás; Arenal, Ángel; Pelliza, Mauricio; Hernández-Hernández, Jesús; Atienza, Felipe; González‐Torrecilla, Esteban; Ávila, Pablo; Bravo, Loreto; Fernández-Avilés, Francisco

doi:10.1016/j.amjcard.2013.11.030

Cited by 28 publications

(18 citation statements)

References 17 publications

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“…The non-magnetic robotic systems for ablation are based on robotic steerable sheaths. 6 , 7 These systems provide robotic assistance for conventional stiff catheters by means of robotic steerable sheaths; 13 , 14 the operator movements are transmitted to the steerable sheath which in turn directs the catheter.…”

Section: Discussionmentioning

confidence: 99%

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

et al. 2015

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AimsThe magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation.Methods and resultsAtrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN–RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN–CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027).ConclusionThe use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced.

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Section: Discussionmentioning

confidence: 99%

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

et al. 2015

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“…Even though a different robotic system was used and no contact force was measured the results of the study by Tilz et al may at least in part apply to the RCS used in our protocol. Large randomized prospective trials are missing, but numerous studies on initial experience with the RCS support the view that robotic ablation with the RCS is safe [7][8][9] .…”

Section: Discussionmentioning

confidence: 99%

“…A novel robotic system with remote catheter steerability has recently been introduced. Feasibility and efficacy of this system for PVI and other electrophysiological procedures, such as AV-nodal-reentry-tachcardia, accessory pathways or atrial flutter and atrial or ventricular tachycardias has been evaluated [7][8][9] . A significant reduction of operator fluoroscopy exposure compared to manual ablation was shown, while all other procedural parameters and success rate at 12-month follow up were not significantly different 7 .…”

Section: Introductionmentioning

confidence: 99%

Robotic Ablation of Atrial Fibrillation

Wutzler

Wölber

Haverkamp

et al. 2015

JoVE

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Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 -40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.

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“…There is a developing technology that involves the use of remotely controlled magnetic and active catheters, where physicians may perform catheterization procedures from a distance or at a separate workstation. 2 – 16 …”

Section: Introductionmentioning

confidence: 99%

Feedforward Coordinate Control of a Robotic Cell Injection Catheter

Cheng

Law

2017

Cell Transplant

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Remote and robotically actuated catheters are the stepping-stones toward autonomous catheters, where complex intravascular procedures may be performed with minimal intervention from a physician. This article proposes a concept for the positional, feedforward control of a robotically actuated cell injection catheter used for the injection of myogenic or undifferentiated stem cells into the myocardial infarct boundary zones of the left ventricle. The prototype for the catheter system was built upon a needle-based catheter with a single degree of deflection, a 3-D printed handle combined with actuators, and the Arduino microcontroller platform. A bench setup was used to mimic a left ventricle catheter procedure starting from the femoral artery. Using Matlab and the open-source video modeling tool Tracker, the planar coordinates (y, z) of the catheter position were analyzed, and a feedforward control system was developed based on empirical models. Using the Student’s t test with a sample size of 26, it was determined that for both the y- and z-axes, the mean discrepancy between the calibrated and theoretical coordinate values had no significant difference compared to the hypothetical value of µ = 0. The root mean square error of the calibrated coordinates also showed an 88% improvement in the z-axis and 31% improvement in the y-axis compared to the unmodified trial run. This proof of concept investigation leads to the possibility of further developing a feedfoward control system in vivo using catheters with omnidirectional deflection. Feedforward positional control allows for more flexibility in the design of an automated catheter system where problems such as systemic time delay may be a hindrance in instances requiring an immediate reaction.

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Comparison of the Safety and Feasibility of Arrhythmia Ablation Using the Amigo Robotic Remote Catheter System Versus Manual Ablation

Cited by 28 publications

References 17 publications

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

Robotic Ablation of Atrial Fibrillation

Feedforward Coordinate Control of a Robotic Cell Injection Catheter

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