Initial Experience With Remote Catheter Ablation Using a Novel Magnetic Navigation System

Abstract

Background-Catheters are typically stiff and incorporate a pull-wire mechanism to allow tip deflection. While standing at the patient's side, the operator manually navigates the catheter in the heart using fluoroscopic guidance. Methods and Results-A total of 42 patients (32 female; mean age, 55Ϯ15 years) underwent ablation of common-type (slow/fast) or uncommon-type (slow/slow) atrioventricular nodal reentrant tachycardia (AVNRT) with the use of the magnetic navigation system Niobe (Stereotaxis, Inc). It consists of 2 computer-controlled permanent magnets located on opposite sides of the patient, which create a steerable external magnetic field (0.08 T). A small magnet embedded in the catheter tip causes the catheter to align and to be steered by the external magnetic field. A motor drive advances or retracts the catheter, enabling complete remote navigation. Radiofrequency current was applied with the use of a remote-controlled 4-mm, solid-tip, magnetic navigation-enabled catheter (55°C, maximum 40 W, 60 seconds) in all patients. The investigators, who were situated in the control room, performed the ablation using a mean of 7.2Ϯ4.7 radiofrequency current applications (mean fluoroscopy time, 8.9Ϯ6.2 minutes; procedure duration, 145Ϯ43 minutes). Slow pathway ablation was achieved in 15 patients, whereas slow pathway modulation was the end point in the remaining patients. There were no complications. Conclusions-The Niobe magnetic navigation system is a new platform technology allowing remote-controlled navigation of an ablation catheter. In conjunction with a motor drive unit, this system was used successfully to perform completely remote-controlled mapping and ablation in patients with AVNRT.

Remote Magnetic Navigation With Irrigated Tip Catheter for Ablation of Paroxysmal Atrial Fibrillation

“…1,2 The remote magnetic navigation system (MNS) [3][4][5][6][7][8] has been introduced recently into clinical practice, which allows the use of a soft-tipped ablation catheter that can be guided to and positioned at the desired site by directional magnetic fields. On the other hand, the MNS is available and has been used with a nonirrigated magnetic tip catheter for RF ablation.…”

An in vivo comparison of radiofrequency cardiac lesions formed by standard and magnetically steered 4 mm tip catheters

“…7,[10][11][12][13][14][15][16] Comparison of standard vs. magnetic catheters Ablation lesions formed by magnetically steered catheters have similar characteristics to those from standard catheters. The only significant differences appear to be that the lesions from magnetically steered catheters are more round or oval rather than elongated, suggesting more constant catheter tissue contact.…”

The Amigo™ Remote Catheter System: From Concept to Bedside

“…The Niobe s magnetic navigation system (Sterotaxis, Inc., St. Louis, MO, USA) utilizes two computer-controlled permanent magnets to create a magnetic field in the patient's chest. 9,10 This system requires the use of flexible catheters that incorporate a permanent magnet inside the tip, to allow for the manipulation of their movement through the adjustment of the magnetic field's orientation. [9][10][11] During use, the catheter is advanced and withdrawn using a motor-driven unit (Cardiodrive s ; Sterotaxis, Inc., St. Louis, MO, USA) and is maneuvered by the operator, who is in the control room, through a video workstation (Navigantt; Sterotaxis, Inc., St. Louis, MO, USA).…”

“…[9][10][11] During use, the catheter is advanced and withdrawn using a motor-driven unit (Cardiodrive s ; Sterotaxis, Inc., St. Louis, MO, USA) and is maneuvered by the operator, who is in the control room, through a video workstation (Navigantt; Sterotaxis, Inc., St. Louis, MO, USA). 9,10 The Niobe s system (Sterotaxis, Inc., St. Louis, MO, USA) is exceptionally accurate in achieving catheter positioning and is unlikely to cause cardiac perforation 11 since it utilizes a soft catheter that is pulled towards the endocardium by an external magnetic field, rather than a mechanically driven rigid catheter. However, this system is very expensive, and a physically large EP laboratory is required to accommodate its sizeable platform.…”