View-synchronized robotic image-guided therapy for atrial fibrillation ablation - Experimental validation and clinical feasibility
View-synchronized robotic image-guided therapy for atrial fibrillation ablation - Experimental validation and clinical feasibility
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DOI：
10.1161/circulationaha.106.677369
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发表时间：
2007-05-29
期刊：
影响因子：
37.8
通讯作者：
Ruskin, Jeremy N.
中科院分区：
文献类型：
--
作者：
Reddy, Vivek Y.;Neuzil, Petr;Ruskin, Jeremy N.
背景-机器人导管导航系统已经被开发出来，它提供了相当大的导管移动自由度。本研究探讨了将该机器人导航系统与电解剖标测和三维CT成像同步进行左房消融的可行性。方法和结果：本研究包括猪实验验证阶段(9只动物)和临床可行性阶段(9例房颤患者)。术前CT图像重建以提供LA肺静脉和主动脉的三维表面模型。手动执行主动脉电解剖标测，然后使用定制软件与相应的计算机断层扫描图像配准。在注册的LA肺静脉计算机断层扫描图像内，利用机器人导航系统远程操纵标测导管。在临床前研究和临床研究中，LA电解剖标测数据与CT图像之间的点到面误差分别为2.1±0.7 mm和1.6±0.1 mm。导管被远程导航到所有肺静脉、左心耳，并沿二尖瓣环周向插入。在9只动物中，7只在骨膜周缘应用射频消融术消融11条肺静脉。在患者中，所有的肺静脉都以腔外方式进行远程电隔离。辅助消融包括6例分离上腔静脉，5例消融三尖瓣峡部，3例消融复杂的分段性活动和不典型的左房扑动。结论：本研究证实了一种融合了三维成像、电解剖标测和远程机器人导航三种技术的房颤消融的安全性和可行性。
Background - A robotic catheter navigation system has been developed that provides a significant degree of freedom of catheter movement. This study examines the feasibility of synchronizing this robotic navigation system with electroanatomic mapping and 3-dimensional computed tomography imaging to perform view- synchronized left atrial (LA) ablation.Methods and Results - This study consisted of a porcine experimental validation phase (9 animals) and a clinical feasibility phase (9 atrial fibrillation patients). Preprocedural computed tomography images were reconstructed to provide 3-dimensional surface models of the LA pulmonary veins and aorta. Aortic electroanatomic mapping was performed manually, followed by registration with the corresponding computed tomography aorta image using custom software. The mapping catheter was remotely manipulated with the robotic navigation system within the registered computed tomography image of the LA pulmonary veins. The point-to-surface error between the LA electroanatomic mapping data and the computed tomography image was 2.1 +/- 0.7 and 1.6 +/- 0.1 mm in the preclinical and clinical studies, respectively. The catheter was remotely navigated into all pulmonary veins, the LA appendage, and circumferentially along the mitral valve annulus. In 7 of 9 animals, circumferential radiofrequency ablation lesions were applied periostially to ablate 11 pulmonary veins. In patients, all of the pulmonary veins were remotely electrically isolated in an extraostial fashion. Adjunctive ablation included superior vena cava isolation in 6 patients, cavotricuspid isthmus ablation in 5 patients, and ablation of sites of complex fractionated activity and atypical LA flutters in 3 patients.Conclusions - This study demonstrates the safety and feasibility of an emerging paradigm for atrial fibrillation ablation involving the confluence of 3 technologies: 3-dimensional imaging, electroanatomic mapping, and remote robotic navigation.