Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath

Abstract

Background A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation. Objective To report our initial experience using this system for remotely performing catheter ablation in humans. Methods Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n=1), atrial flutter (n=2) and atrial fibrillation (n=7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success. Results Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm 2 for all ten ablation procedures. Conclusions Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator.

Remote Robotic Navigation and Electroanatomical Mapping for Ablation of Atrial Fibrillation

“…4 To improve catheter stability and to reduce x-ray exposure, remote navigation (RN) systems have been developed and used in preclinical and clinical settings. [5][6][7][8][9] The aim of this study was to describe the application of a novel remote robotic navigation system during PVI procedures in conjunction with different electroanatomical mapping systems with special emphasis on its ability to reduce the operator's x-ray exposure.…”

Novel Technologies for Mapping and Ablation of Complex Arrhythmias

“…The Artisan sheath maintains the catheter position by the tensile strength of four pullwires so that the shape adopted by the sheath is uniquely suited to the point of interest to which the catheter is being positioned. (Kanagaratnam, Koa-Wing et al 2008) This is in contrast to the manual approach, where the operator has to dynamically apply torque and flexion to prevent the catheter displacing from the point of interest. The Sensei™ robotic control system also incorporates a pressure sensor (Intellisense™), which calculates the contact force at the tip of the catheter using the differential resistance when continuously dithering the catheter in and out of the Artisan sheath.…”

“…This tissue contact pressure enhances the validation of tissue contact and also provides for the ability to identify a pressure curve for optimal lesion production. (Kanagaratnam, Koa-Wing et al 2008) Hansen Robotic Artisan steerable sheath.…”

Catheter Ablation – New Developments in Robotics

“…The function of the RNS has previously been described in detail [5][6][7][8]. In brief, it is an electromechanical system that achieves catheter navigation by two steerable sheaths (Artisan™, Hansen Medical) incorporating an ablation catheter.…”