Experience with the hansen robotic system for atrial fibrillation ablation--lessons learned and techniques modified: Hansen in the real world.
BACKGROUND
The Hansen robotic system has only recently been used in the United States for catheter ablation procedures in humans. Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system.


RESULTS
All 71 patients in whom the system was utilized were included. In all patients, a 2-operator technique was to be employed; one operator manipulates the ablation catheter via the robot and the other manipulates the circular mapping and intracardiac echocardiogram catheters. There was no procedure-related mortality. All vascular complications occurred in the first 25 procedures performed. There were 6 intraoperative procedural-related complications. These included significant vascular complications (n = 4), one of whom required iliac vein stenting, and 2 cardiac tamponade (one related to a pop-phenomenon)-successfully treated by pericardiocentesis. Early complications (n = 3) were 1 tamponade several hours post-procedure, 1 vascular complication, and 1 pericarditis. Late complications included 5 patients with severe pulmonary vein stenosis (all in first 27 patients) and 1 patient with gastroparesis. All complications were successfully managed without persistent morbidity and occurred earlier in our experience. This led to specific alterations in our vascular access and ablation techniques. These include the use of a longer 14 Fr sheath, through which the robotic sheath is more safely advanced. The choice of ablation catheter and titration of power, particularly when the catheter has a perpendicular orientation to the atrial wall, is also important.


CONCLUSIONS
The suggested modifications may make the system easier to use with the potential to reduce complications.
Wazni
Oussama M
OM
Center for Atrial Fibrillation, Cleveland Clinic, Cleveland, Ohio 44195, USA. waznio@ccf.org
Barrett
Conor
C
Martin
David O
DO
Shaheen
Mazen
M
Tarakji
Khaldoun
K
Baranowski
Bryan
B
Hussein
Ayman
A
Callahan
Thomas
T
Dresing
Thomas
T
Bhargava
Mandeep
M
Kanj
Mohamed
M
Tchou
Patrick
P
Natale
Andrea
A
Saliba
Walid
W
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000295:instrumentation*; D014652:Vascular Diseases / Q000209:etiology* / Q000517:prevention & control