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Turagam MK, Atkins D, Tung R, Mansour M, Ruskin J, Cheng J, Di Biase L, Natale A, Lakkireddy D. A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation. J Interv Card Electrophysiol 2017. [DOI: 10.1007/s10840-017-0257-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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SKODA JAN, ARYA ARASH, GARCIA FERMIN, GERSTENFELD EDWARD, MARCHLINSKI FRANCIS, HINDRICKS GERHARD, MILLER JOHN, PETRU JAN, SEDIVA LUCIE, SHA QUN, JANOTKA MAREK, CHOVANEC MILAN, WALDAUF PETR, NEUZIL PETR, REDDY VIVEKY. Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP-VT Multicenter Trial. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S29-37. [DOI: 10.1111/jce.12910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 01/28/2023]
Affiliation(s)
- JAN SKODA
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - ARASH ARYA
- Heart Center, University of Leipzig; Germany
| | - FERMIN GARCIA
- School of Medicine; University of Pennsylvania; Philadephia Pennsylvania USA
| | | | - FRANCIS MARCHLINSKI
- School of Medicine; University of Pennsylvania; Philadephia Pennsylvania USA
| | | | - JOHN MILLER
- Indiana University Health; Bloomington Indiana USA
| | - JAN PETRU
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - LUCIE SEDIVA
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - QUN SHA
- Stereotaxis, Inc; St. Louis MO USA
| | - MAREK JANOTKA
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - MILAN CHOVANEC
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - PETR WALDAUF
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
| | - PETR NEUZIL
- Cardiology Department, Na Homolce Hospital; Prague Czech Republic
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Abstract
Magnetic navigation has been established as an alternative to conventional, manual catheter navigation for invasive electrophysiology interventions about a decade ago. Besides the obvious advantage of radiation protection for the operator who is positioned remotely from the patient, there are additional benefits of steering the tip of a very floppy catheter. This manuscript reviews the published evidence from simple arrhythmias in patients with normal cardiac anatomy to the most complex congenital heart disease. This progress was made possible by the introduction of improved catheters and most importantly irrigated-tip electrodes.
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Affiliation(s)
| | - Sonya V Babu-Narayan
- Department of Cardiology, Royal Brompton Hospital; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton Hospital; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and National Heart and Lung Institute, Imperial College London, London, UK
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Filgueiras-Rama D, Estrada A, Shachar J, Castrejón S, Doiny D, Ortega M, Gang E, Merino JL. Remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures. J Vis Exp 2013. [PMID: 23628883 PMCID: PMC3665328 DOI: 10.3791/3658] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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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Filgueiras-Rama D, Merino JL. The Future of Pulmonary Vein Isolation - Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation? Arrhythm Electrophysiol Rev 2013; 2:59-64. [PMID: 26835042 DOI: 10.15420/aer.2013.2.1.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pulmonary vein isolation is the main goal of atrial fibrillation (AF) ablation to date. Lack of isolation is associated with an increased risk of AF recurrences. Precise navigation to specific target sites, catheter stability and appropriate contact force are requisites for effective radiofrequency applications. Conventional manual-guided point-by-point radiofrequency energy delivery shows limitations to reach them, especially when performed by non-experienced electrophysiologists. New technological alternatives are rapidly arising and becoming clinically available to overcome some of the manual-guided radiofrequency delivery shortcomings. Here, we review the most recent clinical data, potential advantages, shortcomings and future directions of the new ablation strategies for pulmonary vein isolation.
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Affiliation(s)
| | - Jose L Merino
- Head of the Robotic Cardiac Electrophysiology and Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
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Houmsse M, Daoud EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9:59-70. [PMID: 22145841 DOI: 10.1586/erd.11.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation by radiofrequency (RF) energy has successfully eliminated cardiac tachyarrhythmias. RF ablation lesions are created by thermal energy. Electrode catheters with 4-mm-tips have been adequate to ablate arrhythmias located near the endocardium; however, the 4-mm-tip electrode does not readily ablate deeper tachyarrhythmia substrate. With 8- and 10-mm-tip RF electrodes, ablation lesions were larger; yet, these catheters are associated with increased risk for coagulum, char and thrombus formation, as well as myocardial steam rupture. Cooled-tip catheter technology was designed to cool the electrode tip, prevent excessive temperatures at the electrode tip-tissue interface, and thus allow continued delivery of RF current into the surrounding tissue. This ablation system creates larger and deeper ablation lesions and minimizes steam pops and thrombus formation. The purpose of this article is to review cooled-tip RF ablation biophysics and outcomes of clinical studies as well as to discuss future technological improvements.
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Affiliation(s)
- Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, Columbus, USA.
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Sidhu R, Weir-McCall J, Cochennec F, Riga C, DiMarco A, Bicknell C. Evaluation of an Electromagnetic 3D Navigation System to Facilitate Endovascular Tasks: A Feasibility Study. Eur J Vasc Endovasc Surg 2012; 43:22-9. [DOI: 10.1016/j.ejvs.2010.07.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 07/27/2010] [Indexed: 11/26/2022]
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Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias--a systematic review. J Interv Card Electrophysiol 2011; 34:65-71. [PMID: 22180126 PMCID: PMC3342497 DOI: 10.1007/s10840-011-9645-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/13/2011] [Indexed: 11/18/2022]
Abstract
Objective Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT). Methods The National Library of Medicine’s PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system. Results The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0–17%). In ICMP and NICMP, recurrence rates of 0–30% and 14–50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures. Conclusions RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.
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Thakur Y, Jones DL, Skanes A, Yee R, Drangova M. Right-side RF ablation using remote catheter navigation: experimental results in vivo. J Cardiovasc Electrophysiol 2011; 23:81-7. [PMID: 21806702 DOI: 10.1111/j.1540-8167.2011.02142.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The close proximity between the interventionalist and patient during catheter-based interventions for cardiac arrhythmia exposes the interventionalist to harmful radiation. A prototype remote catheter navigation system (RCNS) has been developed to reduce occupational dose. The safety, feasibility of this RCNS and a comparison of remote and conventional navigation techniques is investigated in vivo. METHODS Seven anatomical locations in the right side of the heart in porcine models were chosen as navigation targets. Using fluoroscopy and electrogram analysis, an experienced electrophysiology interventionalist manipulated a radiofrequency (RF) ablation catheter to each target using the RCNS and conventional navigation. Success rate, navigation time, exposure, exposure time and procedure time was recorded for all anatomical targets. Time to integrate the RCNS with the procedure suite was also measured. RESULTS All targets were successfully reached with the RCNS and conventional navigation. No erratic catheter motion was observed with the RCNS whereas 1 operation failure occurred. The anatomical targets were found to have the largest effect on navigation time (P < 0.05), exposure (P < 0.05), and exposure time (P < 0.01), although the navigation method had little to no effect on the metrics. These results suggest that remote navigation procedures can be performed with navigation times comparable to conventional bedside navigation. CONCLUSION Remote navigation with the RCNS may present a safe method of reducing occupational dose, while providing comparable navigation time with conventional bedside navigation.
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Affiliation(s)
- Yogesh Thakur
- Graduate Program in Biomedical Engineering, Robarts Research Institute, London, Ontario, Canada.
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ARYA ARASH, EITEL CHARLOTE, BOLLMANN ANDREAS, WETZEL ULRIKE, SOMMER PHILLIPP, GASPAR THOMAS, HUSSER DANIELLA, PIORKOWSKI CHRISTOPHER, HINDRICKS GERHARD. Catheter Ablation of Scar-Related Ventricular Tachycardia in Patients with Electrical Storm Using Remote Magnetic Catheter Navigation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1312-8. [DOI: 10.1111/j.1540-8159.2010.02818.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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EITEL CHARLOTTE, HINDRICKS GERHARD, SOMMER PHILIPP, WETZEL ULRIKE, BOLLMANN ANDREAS, GASPAR THOMAS, PIORKOWSKI CHRISTOPHER, ARYA ARASH. Safety of Remote Magnetic Navigation in Patients With Pacemakers and Implanted Cardioverter Defibrillators. J Cardiovasc Electrophysiol 2010; 21:1130-5. [DOI: 10.1111/j.1540-8167.2010.01777.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Di Biase L, Santangeli P, Astudillo V, Conti S, Mohanty P, Mohanty S, Sanchez JE, Horton R, Thomas B, Burkhardt JD, Natale A. Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: results from a large single-center case-control series. Heart Rhythm 2010; 7:1029-35. [PMID: 20434589 DOI: 10.1016/j.hrthm.2010.04.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 04/25/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. OBJECTIVE This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). METHODS A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. RESULTS Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 +/- 1.2 hours vs. 3.3 +/- 1.1 hours, P = 0.004) and RF time (24 +/- 12 minutes vs. 33 +/- 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 +/- 22 minutes vs. 26 +/- 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 +/- 2.1 months of follow-up in the study group and 18.7 +/- 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA. CONCLUSION This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St. David Medical Center, Austin, Texas, USA
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Riga CV, Cheshire NJW, Hamady MS, Bicknell CD. The role of robotic endovascular catheters in fenestrated stent grafting. J Vasc Surg 2010; 51:810-9; discussion 819-20. [PMID: 20347674 DOI: 10.1016/j.jvs.2009.08.101] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 06/28/2009] [Accepted: 08/02/2009] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Fenestrated stent grafting has allowed the treatment of complex thoraco-abdominal aneurysm disease via a totally endovascular approach, but the procedure can be technically challenging and time consuming. We investigated whether this procedure may be enhanced by remotely steerable robotic endovascular catheters. METHODS A four-vessel fenestrated stent graft partially deployed within a computed tomography (CT)-reconstructed pulsatile thoraco-abdominal aneurysm silicon model was used. Fifteen operators were recruited to participate in the study and divided into three groups, based on their endovascular experience: group A (n = 4, 100-200 endovascular procedures, group B (n = 5, 200-300), and group C (n = 6, >300). All operators were asked to cannulate the renal and visceral vessels under fluoroscopic guidance, using conventional and robotic techniques. Quantitative (catheterization times and wire/catheter tip movements) and qualitative metrics (procedure-specific-rating scale [IC3ST]), which grades operators on catheter use, instrumentation, successful cannulation/catheterization, and overall performance were compared. RESULTS Median procedure time for cannulation of all four vessels was reduced using the robotic system (2.87 min, interquartile range [IQR; 2.20-3.90] versus 17.24 min [11.90-19.80]; P < .001) for each individual operator, regardless of the level of endovascular experience. The total number of wire/catheter movements taken to complete the task was also significantly reduced (38, IQR [29-57] versus 454 [283-687]; P < .001). There were significant differences in time and movement for cannulation of each individual vessel in the phantom. Robotic catheter operator radiation exposure was negligible as the robotic workstation is remote and away from the radiation source. Overall performance scores significantly improved using the robotic system, despite minimal operator exposure to this technology (IC3ST score 29/35, IQR [22.8-30.7] versus 19/35 [13-24.3]; P = .002). Each group of operators demonstrated an improvement in performance with robotic cannulation. For group A, median IC3ST score was 28/35, IQR (22-33) versus 15/35 (11-20); P = .04; for group B, 30/35 (27-31) versus 19/35 (18-24); P = .07; and for group C, 28.8/35 (28.5-29) versus 22/35 (16-24); P = .06. For groups B and C, these differences did not reach statistical significance. CONCLUSION Robotic catheterization of target vessels during this procedure is feasible and minimizes radiation exposure for the operator. Steerable robotic catheters with intuitive control may overcome some of the limitations of standard catheter technology, enhance target vessel cannulation, reduce instrumentation, and improve overall performance scores.
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Affiliation(s)
- Celia V Riga
- Regional Vascular Unit, Imperial College London, St Mary's Hospital, London, United Kingdom.
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HAGHJOO MAJID, HINDRICKS GERHARD, BODE KERSTIN, PIORKOWSKI CHRISTOPHER, BOLLMANN ANDREAS, ARYA ARASH. Initial Clinical Experience with the New Irrigated Tip Magnetic Catheter for Ablation of Scar-Related Sustained Ventricular Tachycardia: A Small Case Series. J Cardiovasc Electrophysiol 2009; 20:935-9. [DOI: 10.1111/j.1540-8167.2008.01416.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thakur Y, Holdsworth DW, Drangova M. Characterization of Catheter Dynamics During Percutaneous Transluminal Catheter Procedures. IEEE Trans Biomed Eng 2009; 56:2140-3. [DOI: 10.1109/tbme.2008.921148] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sacher F, Tedrow UB, Field ME, Raymond JM, Koplan BA, Epstein LM, Stevenson WG. Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2008; 1:153-61. [PMID: 19808409 DOI: 10.1161/circep.108.769471] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Frédéric Sacher
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Usha B. Tedrow
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Michael E. Field
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Jean-Marc Raymond
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Bruce A. Koplan
- From Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
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ARYA ARASH, KOTTKAMP HANS, PIORKOWSKI CHRISTOPHER, BOLLMANN ANDREAS, GERDES-LI JINHONG, RIAHI SAM, ESATO MASAHIRO, HINDRICKS GERHARD. Initial Clinical Experience with a Remote Magnetic Catheter Navigation System for Ablation of Cavotricuspid Isthmus-Dependent Right Atrial Flutter. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:597-603. [DOI: 10.1111/j.1540-8159.2008.01047.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Refinement of CARTO-guided substrate modification in patients with ventricular tachycardia after myocardial infarction. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200801020-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Schimpf R, Reents T, Hessling G, Deisenhofer I, Pflaumer A, Estner H, Wu J, Ucer E, Zrenner B, Sueselbeck T, Kuschyk J, Veltmann C, Borggrefe M, Wolpert C. [Magnetic navigation in invasive electrophysiological diagnostic and therapy]. Herzschrittmacherther Elektrophysiol 2007; 18:157-65. [PMID: 17891492 DOI: 10.1007/s00399-007-0575-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 06/30/2007] [Indexed: 11/28/2022]
Abstract
Electrophysiological stimulation and ablation is currently performed with manually deflectable catheters of different lengths and curves. Disadvantages of conventional therapy are catheter stiffness, limited local stability, risk of dislocation or perforation, and reduced tissue contact in regions with difficult access. Fluoroscopy to control catheter movement and position may require substantial radiation times. Magnetic navigation was first applied for right heart catherization in congenital heart disease in 1991; the first electrophysiological application took place in 2003. Today, an ablation electrode with small magnets is aligned in the patient's heart by two external magnets positioned at both sides of the thorax. Antegrade and retrograde movement of the distal catheter tip are performed via an external device on the patient's thigh. Three-dimensional MRI scans acquired before intervention can be merged with electroanatomical reconstruction, leading to further reductions of radiation burden. During treatment of supraventricular tachyarrhythmias high local precision of magnetically guided catheters, good local stability, and a substantially reduced radiation time have been reported. First applications in ventricular tachyarrhythmias and complex congenital cardiac defects indicate a comparable effect. Limitations of this therapy are the application in left atrial procedures (open irrigated ablation catheters not yet available), difficult transaortic retrograde approach (high lead flexibility), and the considerable costs. Magnet-assisted navigation is feasible during percutaneous coronary interventions of tortuous coronary arteries and in positioning guidewires in coronary sinus side branches for resynchronisation therapy. Future applications will be complex left atrial procedures, magnetically guided cardiac stem cell therapy, local drug application, and extracardiac vessel therapy.
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Affiliation(s)
- R Schimpf
- I. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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