title: Novel robotic catheter remote control system: feasibility and safety of transseptal puncture and endocardial catheter navigation.
abstract: OBJECTIVE
  The aims of this study were to demonstrate the safety and the feasibility of the robotic catheter remote control system (CCS) in endocardial navigation in all cardiac chambers, as well as facilitation of the transseptal puncture.
  
  
  BACKGROUND
  CCS has been developed to facilitate control and precise positioning of catheters within the cardiovascular system.
  
  
  METHODS
  CCS consists of a remote catheter manipulator, a set up joint, a physician workstation, and a steerable guide catheter (SGC) and sheath. A conventional 4-mm tip catheter was inserted through the SGC to perform mapping of five predefined targets in each cardiac chamber. Seven mongrel dogs were used in this study. Intracardiac echocardiography and three-dimensional (3-D) electroanatomical mapping were integrated with CCS to facilitate catheter manipulation and to guide transseptal puncture. The time to complete the transseptal puncture and the time to complete access to the predefined targets in each cardiac chamber were measured. Gross and microscopic examinations of the accessed and ablation sites were performed to evaluate safety.
  
  
  RESULTS
  Transseptal puncture was performed successfully in all animals with a mean time of 7 +/- 3 minutes. Procedure times to access the five targets in the right atrium, right ventricle, left atrium, and left ventricle were 5.6 +/- 1.7, 4.6 +/- 1.5, 13.5 +/- 11.0, 7.0 +/- 2.9 minutes, respectively. There were no intracardiac damages associated with catheter manipulation noted in the excised hearts.
  
  
  CONCLUSIONS
  Endocardial catheter navigation and mapping using the robotic catheter remote control is safe and feasible. Moreover, the CCS could be used to perform transseptal puncture and left atrial instrumentation.
authors.affiliation: Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Seil
authors.initials: S
authors.lastname: Oh
authors.forename: Youhua
authors.initials: Y
authors.lastname: Zhang
authors.forename: Todor N
authors.initials: TN
authors.lastname: Mazgalev
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000818:Animals; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004285:Dogs; D004699:Endocardium / Q000000981:diagnostic imaging / Q000601:surgery; D004867:Equipment Design; D019544:Equipment Failure Analysis; D004869:Equipment Safety; D005240:Feasibility Studies; D006335:Heart Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D010865:Pilot Projects; D011677:Punctures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D014463:Ultrasonography