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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Atrial Fibrillation Ablation Using a Robotic Catheter Remote Control System

Initial Human Experience and Long-Term Follow-Up Results

Walid Saliba, MD^_*, Vivek Y. Reddy, MD, Oussama Wazni, MD^_*, Jennifer E. Cummings, MD^_*, J. David Burkhardt, MD^_*, Michel Haissaguerre, MD, Josef Kautzner, MD, Petr Peichl, MD, Petr Neuzil, MD^#, Volker Schibgilla, MD^||, Georg Noelker, MD^||, Johannes Brachmann, MD^||, Luigi Di Biase, MD^_*,¶, Conor Barrett, MD^_*, Pierre Jais, MD and Andrea Natale, MD, FACC, FHRS^_**,,,_*

^_* Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France
Department of Cardiology IKEM-Institute for Clinical and Experimental Medicine, Prague, Czech Republic
^|| Department of Cardiology, Klinikum Coburg II, Medizinische Klinik, Coburg, Germany
^¶ Department of Cardiology, University of Foggia, Foggia, Italy
^# Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
^_** Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
Division of Cardiology, Stanford University, Palo Alto, California
Case Western Reserve University, Cleveland, Ohio.

Manuscript received December 27, 2007; revised manuscript received March 3, 2008, accepted March 4, 2008.

^_* Reprint requests and correspondence: Dr. Andrea Natale, Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Suite 516, 1015 East 32nd Street, Austin, Texas 78705. (Email: nataleam{at}roadrunner.com).

Objectives: We present the initial clinical human experience with the use of a robotic remote navigation system (Hansen Medical, Mountain View, California), to perform left and right atrial mapping and radiofrequency ablation of atrial fibrillation (AF) and atrial flutter (AFL).

Background: Catheter ablation is an established curative modality for various arrhythmias. A robotic steerable sheath system (SSS) (Hansen Medical) allows better catheter stability and greater degrees of freedom of catheter movement.

Methods: A total of 40 patients (mean age 57 years) with antiarrhythmic drug (AAD)–refractory AF (23 had also concomitant documented typical AFL) were studied. Three-dimensional reconstruction of the corresponding atrial chamber anatomy was performed with the CARTO electroanatomic mapping system (Biosense Webster, Diamond Bar, California or the EnSite NavX system (St. Jude Medical, Minneapolis, Minnesota) in combination with the Artisan catheter (Hansen Medical). In patients undergoing AF ablation, 2 transseptal punctures were performed under intracardiac ultrasound (ICE) guidance, with one of the punctures being performed using SSS. Pulmonary vein antrum isolation was performed with a 3.5-mm thermocool catheter manipulated with the use of the SSS and was verified by circular mapping. Patients were followed clinically for recurrence of arrhythmia with an event transmitter and ambulatory holter monitoring. Clinical recurrence of AF/AFL was defined as AF/AFL episodes >1 min in duration.

Results: Pulmonary vein antrum isolation was performed in 40 patients, including 23 with concomitant typical AFL ablation. All pulmonary veins, including the superior vena cava, were successfully isolated. In 23 of 40 patients, cavotricuspid ablation was also performed with bidirectional block obtained. At 1-year follow-up, 34 patients (86%) and 5 patients were free from atrial arrhythmia off AADs and on AADs, respectively.

Conclusions: This preliminary human experience suggests that mapping and ablation of AFL and AF using this novel robotic catheter with remote control system is feasible with similar results to conventional approach.

Abbreviations and Acronyms   AAD = antiarrhythmic drug   AF = atrial fibrillation   AFL = atrial flutter   CT = computed tomography   ICE = intracardiac echocardiography   PV = pulmonary vein   SSS = steerable sheath system   SVC = superior vena cava   3D = three-dimensional

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