title: First experience with remote left ventricular mapping and transendocardial cell injection with a novel integrated magnetic navigation-guided electromechanical mapping system.
abstract: OBJECTIVE
  The purpose of this preclinical feasibility study was to evaluate a novel integrated platform in which magnetic navigation is used to remotely guide electromechanical mapping of the left ventricle (LV) and transendocardial cell injections. Using an integrated remote system would greatly facilitate intramyocardial delivery of stem cells for treating ischaemic heart disease.
  
  
  RESULTS
  We used the computer-controlled Stereotaxis magnetic navigation system to guide the NOGA electromechanical mapping system in mapping viable myocardium in the LV of seven pigs. We then tested the feasibility of this system to perform transendocardial injections in three of the pigs and to deliver mesenchymal precursor cells (MPCs) to targeted myocardial segments in four of the pigs. The success or failure of each injection was determined by myocardial contrast staining in the first group and by histopathologic analysis in the last group. The mean time (+/-SD) spent mapping the LV for each pig was 49.3+/-10.6 min. The success rate for transendocardial injections was 94.4%, as indicated by myocardial contrast staining. There was a 95.8% success rate for targeted injections of MPCs, and 4',6-diamidino-2-phenylindole-labeled MPCs were detected in all but one segment of one pig. No epicardial haemorrhage or injury was observed, although there was some venous drainage.
  
  
  CONCLUSIONS
  The integrated Stereotaxis/NOGA system has excellent remote navigability inside the LV cavity while sparing the operator from radiation exposure. This system also allows transendocardial cell injections to be performed with a high success rate. Further studies are needed to define the safety profile of this system for clinical use.
authors.affiliation: Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
authors.forename: Emerson C
authors.initials: EC
authors.lastname: Perin
authors.forename: Guilherme V
authors.initials: GV
authors.lastname: Silva
authors.forename: Marlos R
authors.initials: MR
authors.lastname: Fernandes
authors.forename: Torrey
authors.initials: T
authors.lastname: Munger
authors.forename: Ashwini
authors.initials: A
authors.lastname: Pandey
authors.forename: Ruchir
authors.initials: R
authors.lastname: Sehra
authors.forename: Michael
authors.initials: M
authors.lastname: Talcott
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Bichard
authors.forename: Jerett
authors.initials: J
authors.lastname: Creed
authors.forename: Jonathan W C
authors.initials: JW
authors.lastname: Wong
authors.forename: Edie M
authors.initials: EM
authors.lastname: Oliveira
authors.forename: Yi
authors.initials: Y
authors.lastname: Zheng
authors.forename: John
authors.initials: J
authors.lastname: Canales
authors.forename: Cristiano O
authors.initials: CO
authors.lastname: Cardoso
authors.forename: Mark S
authors.initials: MS
authors.lastname: Patterson
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys