Robotic Ablation of Atrial Fibrillation

Abstract

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.

Safety and feasibility of atrial fibrillation ablation using Amigo ® system versus manual approach: A pilot study

“…All manual and robotic procedures were performed using a Thermocool ® SmartTouch ® ablation catheter (STc) (Biosense Webster Inc., Diamond Bar, California). The Amigo system, which has been previously described in detail [8] , [12] , consists of a robotic arm mounted on the rails at the foot of the procedure table and a remote controller connected to the robotic arm via a cable [ Fig. 1 ].…”

“…The Amigo ® Remote Catheter System (Catheter Precision Inc., Ledgewood, NJ, USA) is a relatively new robotic (electromechanical) system for catheter navigation that allows the use of standard catheters and sheaths. Previously published studies, using the system for a variety of electrophysiologic procedures, have reported good results in terms of efficacy and safety [8] , [9] , [10] , [11] , [12] . The present study is the first designed to use a force-sensing catheter to compare force-related parameters during atrial fibrillation ablation using the Amigo robotic system vs. manual catheter manipulation.…”

Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment

“…The origin of the arrhythmia was believed to be located at the crista terminalis or superior vena cava. A Schwartz Right 0 sheath, which is used to stabilize the catheter, achieved successful ablation, with a contact force of 10 to 20 g and ablation at 30 Watts [ 26 , 31 ]. Non-fluoroscopic ablations can be achieved with intracardiac echocardiography to locate the structures in Koch's triangle.…”

The era of robotics: dexterity for surgery and medical care: narrative review

“…This may be due to its large instrumental dimension needed for entry port sites. 16 Robotics not only has its role in cardio-surgeries but acts as an upheaval for cardiologists to intervene in their clinical scenarios using Cor Path 200 robot system. It has a remote interventional cockpit and bedside disposable cassette for conducting percutaneous coronary intervention.…”