Novel robotic catheter manipulation system integrated with remote magnetic navigation for fully remote ablation of atrial tachyarrhythmias: a two-centre evaluation.
OBJECTIVE
Studies have shown that remote magnetic navigation is safe and effective for ablation of atrial arrhythmias, although optimal outcomes often require frequent manual manipulation of a circular mapping catheter. The Vdrive robotic system ('Vdrive') was designed for remote navigation of circular mapping catheters to enable a fully remote procedure. This study details the first human clinical experience with remote circular catheter manipulation in the left atrium.


RESULTS
This was a prospective, multi-centre, non-randomized consecutive case series that included patients presenting for catheter ablation of left atrial arrhythmias. Remote systems were used exclusively to manipulate both the circular mapping catheter and the ablation catheter. Patients were followed through hospital discharge. Ninety-four patients were included in the study, including 23 with paroxysmal atrial fibrillation (AF), 48 with persistent AF, and 15 suffering from atrial tachycardias. The population was predominately male (77%) with a mean age of 60.5 ± 11.7 years. The Vdrive was used for remote navigation between veins, creation of chamber maps, and gap identification with segmental isolation. The intended acute clinical endpoints were achieved in 100% of patients. Mean case time was 225.9 ± 70.5 min. Three patients (3.2%) crossed over to manual circular mapping catheter navigation. There were no adverse events related to the use of the remote manipulation system.


CONCLUSIONS
The results of this study demonstrate that remote manipulation of a circular mapping catheter in the ablation of atrial arrhythmias is feasible and safe. Prospective randomized studies are needed to prove efficiency improvements over manual techniques.
Department of Cardiology,  Heart and Diabetes Center North Rhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen,  Germany.
Georg
G
Nölker
Klaus-Jürgen
KJ
Gutleben
Bogdan
B
Muntean
Jürgen
J
Vogt
Dieter
D
Horstkotte
Lara
L
Dabiri Abkenari
Ferdi
F
Akca
Tamas
T
Szili-Torok
D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005858:Germany; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008846:Micromanipulation / Q000295:instrumentation; D008875:Middle Aged; D009426:Netherlands; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D018511:Systems Integration; D017216:Telemedicine / Q000295:instrumentation*; D016896:Treatment Outcome