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Lin W, Zhang L, Wu S, Yang F, Zhang Y, Xu X, Zhu F, Fei Z, Shentu L, Han Y. Optimizing the management of electrophysiology labs in Chinese hospitals using a discrete event simulation tool. BMC Health Serv Res 2024; 24:67. [PMID: 38216934 PMCID: PMC10787488 DOI: 10.1186/s12913-024-10548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The growing demand for electrophysiology (EP) treatment in China presents a challenge for current EP care delivery systems. This study constructed a discrete event simulation (DES) model of an inpatient EP care delivery process, simulating a generalized inpatient journey of EP patients from admission to discharge in the cardiology department of a tertiary hospital in China. The model shows how many more patients the system can serve under different resource constraints by optimizing various phases of the care delivery process. METHODS Model inputs were based on and validated using real-world data, simulating the scheduling of limited resources among competing demands from different patient types. The patient stay consists of three stages, namely: the pre-operative stay, the EP procedure, and the post-operative stay. The model outcome was the total number of discharges during the simulation period. The scenario analysis presented in this paper covers two capacity-limiting scenarios (CLS): (1) fully occupied ward beds and (2) fully occupied electrophysiology laboratories (EP labs). Within each CLS, we investigated potential throughput when the length of stay or operative time was reduced by 10%, 20%, and 30%. The reductions were applied to patients with atrial fibrillation, the most common indication accounting for almost 30% of patients. RESULTS Model validation showed simulation results approximated actual data (137.2 discharges calculated vs. 137 observed). With fully occupied wards, reducing pre- and/or post-operative stay time resulted in a 1-7% increased throughput. With fully occupied EP labs, reduced operative time increased throughput by 3-12%. CONCLUSIONS Model validation and scenario analyses demonstrated that the DES model reliably reflects the EP care delivery process. Simulations identified which phases of the process should be optimized under different resource constraints, and the expected increases in patients served.
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Affiliation(s)
- Wenjuan Lin
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lin Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shuqing Wu
- Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Fang Yang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yueqing Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaoying Xu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Fei Zhu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Zhen Fei
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lihua Shentu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yi Han
- Health Economic Research Institute, Sun Yat-sen University, 132 East Waihuan Road, Guangzhou, Guangdong Province, 510006, PR China.
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Noten AME, Romanov A, De Schouwer K, Beloborodov V, Bhagwandien R, Hoogendijk MG, Mikheenko I, Wijchers S, Yap SC, Schwagten B, Szili-Torok T. Robotic magnetic navigation-guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation when compared to conventional ablation techniques. J Cardiovasc Electrophysiol 2023; 34:2472-2483. [PMID: 37767745 DOI: 10.1111/jce.16081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is a pivotal part of ablative therapy for atrial fibrillation (AF). Currently, there are multiple techniques available to realize PVI, including: manual-guided cryoballoon (MAN-CB), manual-guided radiofrequency (MAN-RF), and robotic magnetic navigation-guided radiofrequency ablation (RMN-RF). There is a lack of large prospective trials comparing contemporary RMN-RF with the more conventional ablation techniques. This study prospectively compared three catheter ablation techniques as treatment of paroxysmal AF. METHODS This multicenter, prospective study included patients with paroxysmal AF who underwent their first ablation procedure. Procedural parameters (including procedural efficiency), complication rates, and freedom of AF during 12-month follow-up, were compared between three study groups which were defined by the utilized ablation technique. RESULTS A total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN-CB (78 ± 21 min) compared to MAN-RF (115 ± 41 min; p < .001) and compared to RMN-RF (129 ± 32 min; p < .001), whereas it was comparable between the two radiofrequency (RF) groups (p = .062). A 3% complication rate was observed, which was comparable between all groups. At 12-month follow-up, AF recurrence was observed in 40 patients (19%) and was significantly lower in the robotic group (MAN-CB 19 [24%], MAN-RF 16 [23%], RMN-RF 5 [8%] AF recurrences, p = .045) (multivariate hazard ratio of RMN-RF on AF recurrence 0.32, 95% confidence interval: 0.12-0.87, p = .026). CONCLUSION RMN-guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time-efficient ablation technique, whereas RMN nowadays has comparable efficiency with manual RF ablation.
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Koen De Schouwer
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Vladimir Beloborodov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Rohit Bhagwandien
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Igor Mikheenko
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Bruno Schwagten
- Department of Cardiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Gagyi RB, Yap SC, Noten AME, Wijchers S, Szili-Torok T. The performance of dipole charge density mapping integrated with robotic magnetic navigation in the treatment of atrial tachycardias. J Interv Card Electrophysiol 2023; 66:2103-2111. [PMID: 37076739 PMCID: PMC10694103 DOI: 10.1007/s10840-023-01552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure. METHODS All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups. RESULTS A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21). CONCLUSIONS AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.
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Affiliation(s)
- Rita B Gagyi
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sing-Chien Yap
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Anna M E Noten
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Sip Wijchers
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands
| | - Tamas Szili-Torok
- Thoraxcenter, Department of Clinical Electrophysiology, Postbus 2040, 3000 CA Rotterdam, Molewaterplein 40, 3015 GD Rotterdam, Erasmus, MC, The Netherlands.
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Gagyi RB, Noten AM, Wijchers S, Yap SC, Bhagwandien RE, Hoogendijk MG, Szili-Torok T. Dipole charge density mapping integrated in remote magnetic navigation: First-in-human feasibility study. IJC HEART & VASCULATURE 2022; 42:101095. [PMID: 35899072 PMCID: PMC9309500 DOI: 10.1016/j.ijcha.2022.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
Aims Robotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures. Material and methods In this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared. Results AcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p < 0.01; 181.0 vs. 131.0 mGy, p = 0.02, respectively). Procedure duration and fluoroscopy use decreased significantly between the first 30 and the last 30 AcQMap-RMN procedures. The AcQMap-RMN system had fewer recurrences after persistent AF ablations and was non-inferior in paroxysmal AF patients compared to CARTO-RMN at 12 months (36.6% vs. 75.0%, p = 0.04, PAF 6.6% vs. 12.5%, p = 0.58; respectively). CA of AT outcomes were better using the AcQMap-RMN system (1 year recurrence 17.1% vs. 38.7%, p < 0.05). Conclusion AcQMap-RMN integration has no negative impact on the excellent safety profile of RMN guided ablations. It improves outcomes of CA procedures for persAF and AT but requires longer procedure times and higher fluoroscopy use during the initial learning phase.
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Zheng J, Wang M, Tang QF, Xue F, Li KL, Dang SP, Liu XY, Zhao XX, Zhang CY, Yu ZM, Han B, Jiang TB, Yao Y, Wang RX. Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism. Front Cardiovasc Med 2021; 8:777355. [PMID: 34926624 PMCID: PMC8671737 DOI: 10.3389/fcvm.2021.777355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates. Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X2 = 20.63 P < 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure. Conclusions: Ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation. Clinical Trial Registration: ChiCTR2100046505.
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Affiliation(s)
- Jie Zheng
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Meng Wang
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Qun-Feng Tang
- Department of Radiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Feng Xue
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Ku-Lin Li
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Shi-Peng Dang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Xiao-Yu Liu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Xiao-Xi Zhao
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Chang-Ying Zhang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Zhi-Ming Yu
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Bing Han
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China
| | - Ting-Bo Jiang
- Department of Cardiology, The First Hospital Affiliated to Soochow University, Suzhou, China
| | - Yan Yao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Ru-Xing Wang
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, China
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Noten AME, Kammeraad JAE, Ramdat Misier NL, Wijchers S, van Beynum IM, Dalinghaus M, Krasemann TB, Yap SC, de Groot NMS, Szili-Torok T. Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation. IJC HEART & VASCULATURE 2021; 37:100881. [PMID: 34646933 PMCID: PMC8495098 DOI: 10.1016/j.ijcha.2021.100881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective This study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia. Results In total, we included 223 patients, aged 14 (IQR 12-16) years; weighting 56 (IQR 47-65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20-41) versus 45 (IQR 29-65) mGy, P = 0.040). Conclusion In pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.
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Key Words
- AP, accessory pathway
- AVNRT, atrioventricular nodal reentry tachycardia
- AVRT, atrioventricular reentry tachycardia
- Atrioventricular nodal reentry tachycardia
- Atrioventricular reentry tachycardia
- CA, catheter ablation
- CHD, congenital heart defect
- CRYO, cryoablation
- Catheter ablation
- Cryoablation
- DAP, dose area product
- EAM, electro-anatomic mapping
- ECG, electrocardiogram
- MAN, manual
- Pediatrics
- RF, radiofrequency
- RMN, remote magnetic navigation
- Radiofrequency ablation
- Remote magnetic navigation
- SVT, supraventricular tachycardia
- Supraventricular tachycardia
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Nawin L Ramdat Misier
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Thomas B Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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