Robotic Navigation in Catheter Ablation for Paroxysmal Atrial Fibrillation: Midterm Efficacy and Predictors of Postablation Arrhythmia Recurrences

Hlivák, Peter; Mlčochová, Hanka; Peichl, Petr; Čihák, Robert; Wichterle, Dan; Kautzner, F.E.S.C. Josef

doi:10.1111/j.1540-8167.2010.01942.x

Cited by 57 publications

(39 citation statements)

References 16 publications

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“…In a previously published study, is was shown that left atrial mapping and PVI with the RCS is feasible and effective. No major complication was observed 7 , confirming previously published results on the safety of robotic ablation 12,13 . Operator fluoroscopy exposure is significantly lower without decrease of procedural success rates 7 .…”

Section: Discussionsupporting

confidence: 79%

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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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Section: Discussionsupporting

confidence: 79%

“…Advance a circular mapping catheter via the long sheath into the LA (circular mapping catheter shown in Figure 2B). 13. Perform a 3-D anatomical reconstruction of the LA with the use of a mapping system and the circular mapping catheter.…”

Section: Pre-ablation Preparationmentioning

confidence: 99%

Robotic Ablation of Atrial Fibrillation

Wutzler

Wölber

Haverkamp

et al. 2015

JoVE

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“…Special catheters with magnets affixed to their distal end can be navigated PV isolation reports in paroxysmal and persistent AF patients using the Sensei system have consistently shown significant shortening of the fluoroscopy time. [48][49][50][51][52] Remote isolation of the PV showed similar midterm follow-up (six-months to one-year) free of atrial arrhythmias to manual point-by-point radiofrequency delivery. Without adjunctive antiarrhythmic drugs ≈70 % of paroxysmal AF patients remained free of atrial arrhythmias.…”

Section: Pulmonary Vein Isolation By Remote Navigationmentioning

confidence: 92%

“…Without adjunctive antiarrhythmic drugs ≈70 % of paroxysmal AF patients remained free of atrial arrhythmias. [50][51][52] Initial reports using the Sensei system had raised the concern of higher rate of cardiac tamponade than conventional manual RF delivery 53 , which might be related to remote manipulation of the stiff steerable Artisan catheter (Hansen Medical, Mountain View, CA, US). Further experience and introduction of a special feature of the system to indirectly estimate catheter contact force on the tissue (IntelliSense) have shown that tamponade rates are not greater than the conventional manual approach and may be more related to different temperature and power RF settings.…”

Section: Pulmonary Vein Isolation By Remote Navigationmentioning

confidence: 99%

The Future of Pulmonary Vein Isolation – Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation?

Filgueiras-Rama¹,

Merino

2013

Arrhythmia &Amp; Electrophysiology Review

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59Atrial fibrillation (AF) is the most common sustained arrhythmia in the clinical practice. 1 The prevalence of the arrhythmia is progressively increasing in developed countries and moreover, it is expected to affect up to 12 million people only in the US by 2050.2 Antiarrhythmic drugs continue to represent the first-line of treatment in AF patients, either to restore sinus rhythm or to prevent recurrences.3 However, current antiarrhythmic drugs usually do not achieve complete elimination of the arrhythmia burden and do not have a wide safety profile.4,5 Surgical elimination of certain arrhythmogenic substrates such as AF may represent a therapeutic option. 6 However, nowadays catheter-based ablation is the most common alternative to treat symptomatic patients when antiarrhythmic drugs fail. 3 The cornerstone radiofrequency (RF) catheter-based procedure pioneered by Haïssaguerre and colleagues, of ablating ectopic triggers that arise from the pulmonary veins (PV) in paroxysmal AF, 7 has progressively evolved to new technical developments aiming to simplify pulmonary vein isolation and increase safety. 8 To reach such objectives it is essential to increase catheter stability, achieve predictable lesion formation, reduce procedure and X-ray exposure time, and make simple and automatic either different steps or the whole procedure by using an anatomically-based ablation approach.The so-called single-shot devices for PV isolation, robotic catheter navigation and ablation, contact force-controlled catheter ablation and new realtime imaging of endocardial ablation are the main available technological breakthroughs intending to overcome some of the conventional manual-guided RF delivery shortcomings. The present review is focused on compiling current clinical data, potential advantages and shortcomings of these new ablation strategies for PV isolation. Single-shot DevicesSeveral single-shot devices have been developed in recent years to facilitate PV isolation, based on the encouraging aim of achieving complete isolation of the vein after one single application (single-shot) using circular catheters or balloon-like ablation devices. Among these devices, high-intensity focused ultrasound (HIFU) applied via a balloon catheter (BC) integrates a 9 megahertz (MHz) ultrasound crystal, which generates a ring of ultrasound energy at the base of the balloon. The third generation of HIFU-BC (12 French of outer diameter) is steerable through a pull wire mechanism integrated in the handle of the catheter and is available in balloon sizes (sonication ring diameter) of 24 millimetres (mm) (20 mm), 27 mm (25 mm) and 32 mm (30 mm), respectively (ProRhythm Inc, Ronkonkoma, New York, US). The catheter also has a lumen for insertion of a hexapolar spiral mapping catheter to record PV potentials.Beyond the circumferential lesion design instead of point-by-point ablation, the technology has the potential benefit of not being critically dependent on balloon-to-tissue contact. Initial reports using first and second generation HIFU balloon c...

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“…Further experience and introduction of a special feature of the system to indirectly estimate catheter contact force on the tissue (IntelliSense) have shown that tamponade rates are not superior to conventional manual approach and may be more related to different temperature and power radiofrequency settings. 20 The CGCI system does not require a lab with specific magnetic isolation since the magnetic field is highly focused on patient's torso. In addition, the electrophysiology room can be used either as a conventional electrophysiology lab or as a magnetic lab by moving patient's table from its regular position towards the magnetic chamber.…”

Section: Discussionmentioning

confidence: 99%

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

Filgueiras-Rama

Estrada

Shachar

et al. 2013

JoVE

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New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate.

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Robotic Navigation in Catheter Ablation for Paroxysmal Atrial Fibrillation: Midterm Efficacy and Predictors of Postablation Arrhythmia Recurrences

Abstract: This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow-up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium.

Cited by 57 publications

References 16 publications

Robotic Ablation of Atrial Fibrillation

Robotic Ablation of Atrial Fibrillation

The Future of Pulmonary Vein Isolation – Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation?

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

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