Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

Roy, Karine; Gómez-Pulido, Federico; Ernst, Sabine

doi:10.1111/jce.12903

Cited by 31 publications

(15 citation statements)

References 65 publications

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“…In addition to facilitating anatomic orientation, depiction of the catheter may reduce fluoroscopy. Remote navigation in combination with image integration has been shown to reduce fluoroscopy exposure even in very complex anatomy 35 36. Irrigated tip ablation catheters provide sufficient lesion size and depth, and steerable sheaths improve catheter stability.…”

Section: Long-term Treatment Options Of Svt In Patients With Achdmentioning

confidence: 99%

Management of supraventricular arrhythmias in adults with congenital heart disease

Wasmer

Eckardt

2016

Heart

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Supraventricular arrhythmias are a frequent complication in adults with congenital heart disease (ACHD). The prevalence increases with time since surgery, complexity of the underlying defect, type of repair and older age at surgery. Arrhythmias are the most frequent reason for hospital admission and along with heart failure the leading cause of death. The arrhythmia-associated increase in morbidity and mortality makes their management a key task in patients with ACHD. Intra-atrial re-entry is the most frequent arrhythmia mechanism. Less common arrhythmia mechanisms are supraventricular tachycardias in the presence of an accessory pathway, atrioventricular nodal re-entrant tachycardia or focal tachycardias. Patient management includes stroke prevention, acute termination and prevention of arrhythmia recurrence. Acute treatment depends on patients' symptoms. In cases of haemodynamic instability, immediate cardioversion is warranted. For stable patients, acute treatment includes rate control and termination by antiarrhythmic drugs or electrical cardioversion. Following a symptomatic arrhythmia, catheter ablation or treatment with antiarrhythmic drugs is recommended to prevent recurrences. Advances in mapping and ablation technology are now associated with high success rates of catheter ablation. In patients with a complex substrate recurrence rates of 50% remain high. However, in the presence of side effects and complications associated with long-term antiarrhythmic drug therapy, redo procedures are encouraged by current guidelines.

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Section: Long-term Treatment Options Of Svt In Patients With Achdmentioning

confidence: 99%

Management of supraventricular arrhythmias in adults with congenital heart disease

Wasmer

Eckardt

2016

Heart

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“…For patients with congenital heart disease, RMN can provide access to target chambers that would otherwise be difficult with manual catheter manipulation. RMN can be used for treatment of patients with surgical repair or palliation such as large atrial septal defect closure, total cavopulmonary connection, or Mustard/Senning operations 6 . For example, in cases where transseptal or trans‐baffle access is not possible, a retrograde transaortic approach can be used to access the left atrium.…”

Section: Overview Of Robotic Technology In Cardiac Electrophysiologymentioning

confidence: 99%

“…There are currently limited data on the use of RMN in patients with congenital heart disease or in challenging anatomic locations such as the LV summit. These are areas where RMN may confer specific advantages over manual ablation and should be subject to further study 6 …”

Section: Outcomes With Robotic‐assisted Catheter Ablationmentioning

confidence: 99%

“…RMN can be used for treatment of patients with surgical repair or palliation such as large atrial septal defect closure, total cavopulmonary connection, or Mustard/Senning operations. 6 For example, in cases where transseptal or trans-baffle access is not possible, a retrograde transaortic approach can be used to access the left atrium. In patients without congenital heart disease, RMN can also facilitate access for treatment of more common arrhythmias.…”

Section: Stereotaxis Magnetic Navigation Systemmentioning

confidence: 99%

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

Bassil

Markowitz

Liu

et al. 2020

Cardiovasc electrophysiol

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Robotic technology has emerged as an important tool to facilitate catheter ablation of arrhythmias. Robotic cardiac electrophysiology technology includes remote magnetic navigation and manual robotic navigation. Robotics can confer advantages with respect to ease of catheter manipulation in anatomically challenging spaces, minimization of fluoroscopic exposure to both patients and operators, and reduction in operator fatigue. This review provides a comprehensive summary of robotic electrophysiology technology, its practical applications and its safety and efficacy for targeting cardiac arrhythmias.

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“…In addition, the vector can be directed toward the heart surface, which may reduce the collateral damage seen during epicardial ablation to adjacent structures. Similarly, in congenital heart disease, magnetic navigation may allow access to areas not reachable via manual navigation [11][12][13][14].…”

mentioning

confidence: 99%

Remote magnetic navigation for ventricular ablation: did the machine win this round?

Burkhardt

2016

J Interv Card Electrophysiol

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Remote magnetic navigation has been available as a tool for mapping and ablation for well over a decade. In that period of time, it has shown to be useful in nearly every type of ablation procedure from the most simple to the most complex [1][2][3]. Some operators prefer the system for atrial fibrillation ablation, others for ventricular tachycardia ablation, and some use it for any ablation. Despite numerous publications showing reductions in fluoroscopic exposure and the obvious benefits of not wearing lead and standing tableside for hours, remote magnetic navigation has not become the standard of care in the world [4]. Most publications appear to show similar success rates, and many show favorable complication rates [5][6][7]. So what is the limitation to universal acceptance? In addition, many centers have purchased the system, yet it sits unused. Why would a physician give up a more comfortable procedure to perform an ablation wearing lead and being exposed to more radiation?One of the major factors preventing adoption is cost. Not only is the system itself expensive but it also requires shielding, specific X-ray systems, support specifications, a significant space requirement, and cannot be close to an MRI system. Outfitting an existing EP laboratory with a system would likely require significant construction costs. In general, it is much easier to plan for a system in new construction.Once the system is installed, the operator must commit to overcoming the learning curve. Navigation with the system is quite different than manual navigation. Looping the catheter allows access to areas that cannot be reached directly. There is no fixed curve, which allows great versatility but is not always intuitive. Procedures will take longer in the beginning, and learning the advanced techniques takes significant time and patience. In the current world, where we are pushed toward efficiency and increasing volume and throughput, this time is certainly a sacrifice. It is understandable why some would choose not to continue using a system that slows them down under such pressure.Perhaps the most challenging limitation is technological lag. Magnetic navigation systems require partnerships with catheter manufacturing companies and mapping companies to fully enjoy use of the system. These companies have their own financial goals, and since magnetic navigation is only a small portion of catheter sales, the incentive to advance the technology is not present. Since the release of the open-irrigated magnetic ablation catheter almost 10 years ago, catheter technology has significantly changed. New irrigation platforms, contact force sensing, and balloon-based technologies have entered the field, yet the magnetic catheter has remained unchanged in that time. There is ample opportunity to improve the magnetic catheter itself with increased magnetic force, improved handling, and irrigation, but this cannot occur without significant capital or a willing partner.Despite these limitations, magnetic navigation seems to have found a niche...

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Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

Cited by 31 publications

References 65 publications

Management of supraventricular arrhythmias in adults with congenital heart disease

Management of supraventricular arrhythmias in adults with congenital heart disease

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

Remote magnetic navigation for ventricular ablation: did the machine win this round?

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