title: Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath.
abstract: BACKGROUND
  A novel remotely controlled steerable guide catheter has been developed to enable precise manipulation and stable positioning of any eight French (Fr) or smaller electrophysiological catheter within the heart for the purposes of mapping and ablation.
  
  
  OBJECTIVE
  To report our initial experience using this system for remotely performing catheter ablation in humans.
  
  
  METHODS
  Consecutive patients attending for routine ablation were recruited. Various conventional diagnostic catheters were inserted through the left femoral vein in preparation for treating an accessory pathway (n = 1), atrial flutter (n = 2) and atrial fibrillation (n = 7). The steerable guide catheter was inserted into the right femoral vein through which various irrigated and non-irrigated tip ablation catheters were used. Conventional endpoints of loss of pathway conduction, bidirectional cavotricuspid isthmus block and four pulmonary vein isolation were used to determine acute procedural success.
  
  
  RESULTS
  Ten patients underwent remote catheter ablation using conventional and/or 3D non-fluoroscopic mapping technologies. All procedural endpoints were achieved using the robotic control system without manual manipulation of the ablation catheter. There was no major complication. A radiation dosimeter positioned next to the operator 2.7 m away from the X-ray source showed negligible exposure despite a mean cumulative dose area product of 7,281.4 cGycm(2) for all ten ablation procedures.
  
  
  CONCLUSIONS
  Safe and clinically effective remote navigation of ablation catheters can be achieved using a novel remotely controlled steerable guide catheter in a variety of arrhythmias. The system is compatible with current mapping and ablation technologies Remote navigation substantially reduces radiation exposure to the operator.
authors.affiliation: Waller Cardiology Department, Imperial College and St. Mary's Hospital, Praed Street, London W2 1NY, UK. p.kanagaratnam@imperial.ac.uk
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.forename: Michael
authors.initials: M
authors.lastname: Koa-Wing
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Wallace
authors.forename: Alex S
authors.initials: AS
authors.lastname: Goldenberg
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Peters
authors.forename: D Wyn
authors.initials: DW
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000379:methods; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult