Robotic Catheter Navigation for Ablation
Robotic catheter ablation is performed at some centers. Robotic systems could improve catheter navigation, keep the catheter stable, and shorten procedure times. However, robotic catheter ablations have generally had similar outcomes to traditional (manual) catheter ablation. Thus, the success and complication rates aren’t significantly better or worse.
These robotic systems are expensive, so not all centers have them. Only 10% of 2017 HRS Expert Consensus Statement authors indicated they routinely use a robotic or magnetic system when performing afib catheter ablation procedures.1
Catheter ablation with a single point radiofrequency catheter can be technically challenging to perform, especially for an electrophysiologist (EP) who has not performed many. In theory, using a robot simplifies the procedure and decreases the expertise needed. However, studies haven’t tested this.
A robotic ablation starts the same way as traditional catheter ablation. First, the EP inserts a catheter into the groin and guides the catheter to the right side of the heart. Then, a puncture is made in the septal wall separating the right and left sides of the heart. At that point, the EP leaves the patient’s side and goes to the robotic control system, often in an adjacent room.
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Here are the robotic systems used in catheter ablations, which are typically used according to operator preference.
Niobe is a magnetic system that only works with the CARTO electroanatomic mapping system and Biosense Webster mapping and ablation catheters. It doesn’t look like a robot but is considered a robotic system. The patient’s bed lies between two large magnets that track the movement in the catheter and send the information to the system. The EP uses a joystick similar to those used in video games to change the position of the magnets, making the catheters move. People with a pacemaker or ICD (implantable cardiac defibrillator) may not be able to have a Niobe procedure since these devices may be affected by the magnets.
Catheter Guidance Control and Imaging (CGCI, Magnetecs)
CGCI is a magnetic remote navigation system composed of a magnetic chamber of eight electromagnets around the patient torso. The system can change the magnetic field almost instantaneously and allows manipulation of a special magnetic tip catheter to facilitate heart mapping.
Artis is a multi-purpose system based on robotic technology. Computed tomography (CT) or magnetic resonance imaging (MRI) is overlaid onto fluoroscopic images to guide navigation. The Artis uses different software applications to provide numerous imaging capabilities. These include syngo DynaCT Cardiac (enables CT-like imaging), syngo Electrophysiology Guidance (integrates preprocedural CT and MRI images), and syngo 3D Roadmap and syngo Toolbox (overlays points of interest from 3D volumes onto 2D live images).
To determine whether catheter ablation is appropriate for you, see Are You a Candidate for Catheter Ablation.
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