title: Dynamically shaped magnetic fields: initial animal validation of a new remote electrophysiology catheter guidance and control system.
abstract: BACKGROUND
  To address some of the shortcomings of existing remote catheter navigation systems (RNS), a new magnetic RNS has been developed that provides real-time navigation of catheters within the beating heart. The initial experience using this novel RNS in animals is described.
  
  
  RESULTS
  A real-time, high-speed, closed-loop, magnetic RNS system (Catheter Guidance Control and Imaging) comprises 8 electromagnets that create unique dynamically shaped ("lobed") magnetic fields around the subject's torso. The real-time reshaping of these magnetic fields produces the appropriate 3D motion or change in direction of a magnetized electrophysiology ablation catheter within the beating heart. The RNS is fully integrated with the Ensite-NavX 3D electroanatomic mapping system (St Jude Medical) and allows for both joystick and automated navigation. Conventional and remote navigational mapping of the left atrium were performed using a 4-mm-tip ablation catheter in 10 pigs. A multielectrode transseptal sheath allowed for additional motion compensation. Linear and circumferential radiofrequency lesion sets were performed; in a subset of cases, selective pulmonary vein isolation was also performed. Recording and fluoroscopic equipments were unaffected by the magnetic fields generated by Catheter Guidance Control and Imaging. Automated mode navigation was highly reproducible (96±8.4% of attempts), accurate (1.9±0.4 mm from target site), and rapid (11.6±3.5 seconds to reach targets). At postmortem examination, radiofrequency lesion depth was 78.5±12.1% of atrial wall thickness.
  
  
  CONCLUSIONS
  A new magnetic RNS using a dynamically shaped magnetic field concept can reproducibly and effectively reach target radiofrequency ablation points within the pig left atrium. Validation of the system in clinical settings is under way.
authors.affiliation: Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. gang@cvmg.com
authors.forename: Eli S
authors.initials: ES
authors.lastname: Gang
authors.forename: Bich Lien
authors.initials: BL
authors.lastname: Nguyen
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Shachar
authors.forename: Leslie
authors.initials: L
authors.lastname: Farkas
authors.forename: Laszlo
authors.initials: L
authors.lastname: Farkas
authors.forename: Bruce
authors.initials: B
authors.lastname: Marx
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fishbein
authors.forename: Carlo
authors.initials: C
authors.lastname: Gaudio
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006325:Heart Atria / Q000601:surgery; D060526:Magnetic Fields; D023421:Models, Animal; D011667:Pulmonary Veins / Q000601:surgery; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013552:Swine