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Non-randomised comparison of acute and long-term outcomes of robotic versus manual ventricular tachycardia ablation in a single centre ischemic cohort

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Abstract

Introduction

Robotically guided radiofrequency (RF) ablation offers greater catheter stability that may improve lesion depth. We performed a non-randomised comparison of patients undergoing ventricular tachycardia (VT) ablation either manually or robotically using the Hansen Sensei system for recurrent implantable defibrillator (ICD) therapy.

Methods

Patients with infarct-related scar underwent VT ablation using the Hansen system to assess feasibility compared with patients undergoing manual VT ablation during a similar time period. Power delivery during robotic ablation was restricted to 30 W at 60 s. VT inducibility was checked at the end of the procedure. Pre-ablation ICD therapy burdens over 6 months were compared with post-ablation therapy averaged to a 6-month period.

Results

Twelve consecutive patients who underwent robotic VT ablation were compared to 12 consecutive patients undergoing a manual ablation. Patient demographics and comorbidities were similar in the two groups. A higher proportion of robotic cases were urgent (9/12 (75 %)) vs. manual (4/12 (33 %)) (p = 0.1). Post-ablation VT stimulation did not induce clinical VT in 11/12 (92 %) in each group. There were no peri-procedural complications related to ablation delivery. Patients were followed up for approximately 2 years. Averaged over 6 months, robotic ICD therapy burdens fell from 32 (5–400) events to 2.5 (0–11) (p = 0.015). Therapy burden fell from 14 (10–25) to 1 (0–5) (p = 0.023) in the manual group. There was no difference in long-term outcome (p = 0.60) and mortality (4/12 (33 %), p = 1.0).

Conclusion

Robotically guided VT ablation is both feasible and safe when compared to manual ablation with good acute and long-term outcomes.

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Financial support

This study has been performed independently by the authors listed at Imperial College Healthcare NHS Trust, London, UK. Dr Vishal Luther is funded by a British Heart Foundation Clinical Research Training Fellowship Award (no. FS/15/12/31239). Dr Shahnaz Jamil-Copley is funded by grant PG/10/37/28347 from the British Heart Foundation. We acknowledge the ElectroCardioMaths Programme of the British Heart Foundation Centre of Research Excellence, Programme Grant RG/10/11/28457, and the National Institute for Health Research Biomedical Research Centre. Dr D. Wyn Davies has received consulting fees and research grants from Hansen Medical. Dr Prapa Kanagaratnam has received consulting fees and research grants from Hansen Medical and Biosense Webster.

Authors contributions

VL contributed data analysis/interpretation, statistics and drafting article. SJC contributed data analysis/interpretation, statistics and drafting article and is joint first author. MKW contributed data analysis/interpretation and drafting article. MSS contributed data analysis/interpretation and statistics. IJW, NWL, PBL, ZW, SH, DL, NSP and DWD contributed data collection and approval of article. PK contributed concept/design, critical revision of article and approval of article.

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Authors and Affiliations

  1. Department of Cardiac Electrophysiology, Imperial College Healthcare NHS Trust, London, UK

    Vishal Luther, Shahnaz Jamil-Copley, Michael Koa-Wing, Matthew Shun-Shin, Sajat Hayat, Nicholas W. Linton, Phang Boon Lim, Zachary Whinnett, Ian J. Wright, David Lefroy, Nicholas S. Peters, D. Wyn Davies & Prapa Kanagaratnam

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  1. Vishal Luther
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Correspondence to Prapa Kanagaratnam.

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Luther, V., Jamil-Copley, S., Koa-Wing, M. et al. Non-randomised comparison of acute and long-term outcomes of robotic versus manual ventricular tachycardia ablation in a single centre ischemic cohort. J Interv Card Electrophysiol 43, 175–185 (2015). https://doi.org/10.1007/s10840-015-9992-5

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