Atrial fibrillation ablation using a robotic catheter remote control system: initial human experience and long-term follow-up results.
OBJECTIVE
We present the initial clinical human experience with the use of a robotic remote navigation system (Hansen Medical, Mountain View, California), to perform left and right atrial mapping and radiofrequency ablation of atrial fibrillation (AF) and atrial flutter (AFL).


BACKGROUND
Catheter ablation is an established curative modality for various arrhythmias. A robotic steerable sheath system (SSS) (Hansen Medical) allows better catheter stability and greater degrees of freedom of catheter movement.


METHODS
A total of 40 patients (mean age 57 years) with antiarrhythmic drug (AAD)-refractory AF (23 had also concomitant documented typical AFL) were studied. Three-dimensional reconstruction of the corresponding atrial chamber anatomy was performed with the CARTO electroanatomic mapping system (Biosense Webster, Diamond Bar, California or the EnSite NavX system (St. Jude Medical, Minneapolis, Minnesota) in combination with the Artisan catheter (Hansen Medical). In patients undergoing AF ablation, 2 transseptal punctures were performed under intracardiac ultrasound (ICE) guidance, with one of the punctures being performed using SSS. Pulmonary vein antrum isolation was performed with a 3.5-mm thermocool catheter manipulated with the use of the SSS and was verified by circular mapping. Patients were followed clinically for recurrence of arrhythmia with an event transmitter and ambulatory holter monitoring. Clinical recurrence of AF/AFL was defined as AF/AFL episodes >1 min in duration.


RESULTS
Pulmonary vein antrum isolation was performed in 40 patients, including 23 with concomitant typical AFL ablation. All pulmonary veins, including the superior vena cava, were successfully isolated. In 23 of 40 patients, cavotricuspid ablation was also performed with bidirectional block obtained. At 1-year follow-up, 34 patients (86%) and 5 patients were free from atrial arrhythmia off AADs and on AADs, respectively.


CONCLUSIONS
This preliminary human experience suggests that mapping and ablation of AFL and AF using this novel robotic catheter with remote control system is feasible with similar results to conventional approach.
Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Walid
W
Saliba
Vivek Y
VY
Reddy
Oussama
O
Wazni
Jennifer E
JE
Cummings
J David
JD
Burkhardt
Michel
M
Haissaguerre
Josef
J
Kautzner
Petr
P
Peichl
Petr
P
Neuzil
Volker
V
Schibgilla
Georg
G
Noelker
Johannes
J
Brachmann
Luigi
L
Di Biase
Conor
C
Barrett
Pierre
P
Jais
Andrea
A
Natale
D001281:Atrial Fibrillation / Q000601:surgery* / Q000628:therapy; D001282:Atrial Flutter / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery