Remote robotic catheter ablation for atrial fibrillation: how fast is it learned and what benefits can be earned?
- 202 Downloads
Recently, results describing pulmonary vein isolation (PVI) on patients using a robotic navigation system (RNS) in a high-volume center specialized in pulmonary vein isolation were published. The main purpose of this prospective study was to evaluate the learning curve of new users of RNS in a community hospital and to address the effectivity of RNS in electrophysiological settings with fewer patients. Radiation times, procedural times, feasibility, and safety with the RNS were assessed.
PVI using the RNS was performed on 100 consecutive patients with symptomatic paroxysmal (n = 56, 56%) or persistent atrial fibrillation (AF). To assess the learning curve of practitioners with first-time use of RNS, patients were divided into four groups of 25 patients each (Q1–Q4). Procedural times as well as radiation times, complications, and outcome after a 6-month follow-up period were assessed for each quartile. All patients were ablated by the same physician.
Comparing the four patient groups, a continuous and significant reduction of procedural and radiation times was seen in the first 75 patients (Q1–Q3), whereas no further improvement was seen in the consecutive patients (Q3–Q4). One pericardial tamponade occurred in the course of 100 patients (1%). Overall success rate after a 6-month follow-up period was 74% in patients with paroxysmal and persistent AF. Comparing the four quartiles there was a higher but non-significant number of patients with freedom of atrial fibrillation after a 6-month follow-up in the subsequent groups (Q2–Q4) when compared to group 1.
This data suggest that RNS is feasible and safe when performed in a community hospital with a significant reduction of radiation times and procedure times within the first 75 patients and with similar success and complication rates as compared to high-volume centers.
KeywordsRemote robotic catheter ablation Atrial fibrillation Pulmonary vein isolation Learning experience Catheter ablation
Conflict of interest
- 2.Pappone, C., Oreto, G., Rosanio, S., Vicedomini, G., Tocchi, M., Gugliotta, F., et al. (2001). Atrial electroanatomical remodeling after circumferential radiofrequency pulmonary vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation, 104, 2539–2544.CrossRefPubMedGoogle Scholar
- 4.Kanagaratnam, P., Koa-Wing, M., Wallace, D. T., Goldenberg, A. S., Peters, N. S., & Davies, D. W. (2008). Experience of robotic catheter ablation in humans using a novel remotely steerable catheter sheath. Journal of Interventional Cardiac Electrophysiology, 21(1), 19–26.CrossRefPubMedGoogle Scholar
- 5.Schmidt, B., Tilz, R., Kars Neven, K., Chun, K. R., Fuernkranz, A., & Ouyang, F. (2009). Remote robotic navigation and electroanatomical mapping for ablation of atrial fibrillation. Considerations for navigation and impact on procedural outcome. Circ Arrhythmia Electrophysiol, 2, 120–128.CrossRefGoogle Scholar
- 6.Saliba, W., Reddy, V. Y., Wazni, O., Cummings, J. E., Burkhardt, J. D., Haissaguerre, M., et al. (2008). Atrial fibrillation ablation using a robotic catheter remote control system: Initial human experience and long-term follow-up results. Journal of the American College of Cardiology, 51(25), 2407–2411.CrossRefPubMedGoogle Scholar
- 8.DI Biase, L., Wang, Y., Horton, R., Gallinghouse, G. J., Mohanty, P., Sanchez, J., et al. (2009). Ablation of atrial fibrillation utilizing robotic catheter navigation in comparison to manual navigation and ablation: Single-center experience. Journal of Cardiovascular Electrophysiology, 20(12), 1328–1335.CrossRefPubMedGoogle Scholar
- 9.Rillig, A., Meyerfeldt, U., Kunze, M., Birkemeyer, R., Miljak, T., Jäckle, S., et al. (2010). Persistent iatrogenic atrial septal defect after a single-puncture, double-transseptal approach for pulmonary vein isolation using a remote robotic navigation system: Results from a prospective study. Europace, 12(3), 331–336.CrossRefPubMedGoogle Scholar
- 13.European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Scoiety (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS), Calkins, H., Brugada, J., Packer, D.L., Cappato, R., Chen, S.A., Crijns, H.J., Damiano, R.J. Jr., et al. (2007). HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm, 4(6):816–861.Google Scholar
- 14.Koa-Wing, M., Willis, B., Bowden, S., Salukhe, T.V., Lim, P.B., Linton, N.W.F., Kojodjojo, P., et al. (2008). Learning Experience for Robotically-Assisted Atrial Fibrillation Ablation from an Early Adopting Site. Europace, 10(supplement 2), abstract.Google Scholar
- 15.DI Biase, L., Natale, A., Barrett, C., Tan, C., Elayi, C. S., Ching, C. K., et al. (2009). Relationship between catheter forces, lesion characteristics, "Popping," and char formation: Experience with robotic navigation system. Journal of Cardiovascular Electrophysiology, 20(4), 436–440.CrossRefPubMedGoogle Scholar
- 16.Okumura, Y., Johnson, S. B., Bunch, T. J., Henz, B. D., O'Brien, C. J., & Packer, D. L. (2008). A systematical analysis of in vivo contact forces on virtual catheter tip/tissue surface contact during cardiac mapping and intervention. Journal of Cardiovascular Electrophysiology, 19, 632–640.CrossRefPubMedGoogle Scholar