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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Robotic Magnetic Navigation for Atrial Fibrillation Ablation

Department of Electrophysiology, San Raffaele Scientific Institute, Milan, Italy

Manuscript received August 23, 2005; revised manuscript received November 9, 2005, accepted November 16, 2005.

^_* Reprint requests and correspondence: Dr. Carlo Pappone, Department of Arrhythmology, University Hospital San Raffaele, Via Olgettina, 60, 20132 Milan, Italy (Email: carlo.pappone{at}hsr.it).

OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein ablation (CPVA).

BACKGROUND: No data are available on feasibility of remote navigation for AF ablation.

METHODS: Forty patients underwent CPVA for symptomatic AF using the NIOBE II remote magnetic system (Stereotaxis Inc., St. Louis, Missouri). Ablation was performed with a 4-mm tip, magnetic catheter (65°C, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field (0.08-T), and a motor drive (Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system (Stereotaxis Inc.). End point of ablation was voltage abatement >90% of bipolar electrogram amplitude.

RESULTS: Remote ablation was successful in 38 of 40 patients without complications. The median mapping and ablation time was 152.5 min (range, 90 to 380 min) but was much longer in the first 12 patients (192.5 min vs. 148 min; p = 0.012). Median ablation time was 49.5 min (range, 17 to 154 min), but it was much shorter in the last 28 patients than in the first 12 patients (49 min vs. 70 min; p = 0.021). Patients receiving remote ablation had longer procedure times than control patients (p < 0.001) with similar mapping time but shorter ablation time on right-sided pulmonary veins. Many more mapping points regardless of their location were collected remotely (p < 0.001).

CONCLUSIONS: Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all procedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.

Abbreviations and Acronyms   AF = atrial fibrillation   CPVA = circumferential pulmonary vein ablation   LAO = left anterior oblique   LIPV = left inferior pulmonary vein   LSPV = left superior pulmonary vein   PV = pulmonary vein   RAO = right anterior oblique   RF = radiofrequency

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