Atrial fibrillation ablation using a robotic catheter remote control system - Initial human experience and long-term follow-up results
Atrial fibrillation ablation using a robotic catheter remote control system - Initial human experience and long-term follow-up results
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DOI：
10.1016/j.jacc.2008.03.027
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发表时间：
2008-06-24
影响因子：
24
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
--
作者：
Saliba, Walid;Reddy, Vivek Y.;Natale, Andrea
目的我们介绍了使用机器人远程导航系统（汉森医疗公司，加州，山景）进行左、右心房标测和心房颤动（AF）和心房扑动（AFL）射频消融的初步临床人类经验。一个机器人可操纵鞘管系统（SSS）（汉森医疗）允许更好的导管稳定性和更大程度的自由度的导管movement.Methods共40例（平均年龄57岁）与抗心律失常药物（AAD）难治性房颤（23也伴随记录典型AFL）进行了研究。使用CARTO电解剖标测系统（Biosense韦伯斯特，钻石吧，加州）或EnSite NavX系统（St. Jude Medical，Minneapolis，Minnesota）联合Artisan导管（汉森医疗用品有限公司）对相应的心房腔室解剖结构进行三维重建。在接受AF消融术的患者中，在心内超声（ICE）引导下进行了2次经房间隔穿刺，其中1次穿刺使用SSS进行。使用SSS操作的3.5 mm Thermocool导管进行肺静脉窦隔离，并通过环形标测进行验证。使用事件发送器和动态霍尔特监测对患者进行临床随访，以确定心律失常复发情况。结果40例患者均行肺静脉窦隔离术，其中23例同时行典型房扑消融术。成功分离了所有肺静脉，包括上级腔静脉。在40例患者中，23例还进行了三尖瓣环消融，获得了双向阻滞。在1年的随访中，34例（86%）和5例患者是免费的房性心律失常AADs和AADs.Conclusions，这初步的人类经验表明，标测和消融AFL和AF使用这种新型的机器人导管与远程控制系统是可行的，与传统的方法类似的结果。
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.