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Controlled Clinical Trial
. 2015 Jul;17(7):1045-50.
doi: 10.1093/europace/euu388. Epub 2015 Feb 5.

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

Abdelkarim Errahmouni  1 , Decebal Gabriel Latcu  2 , Sok-Sithikun Bun  2 , Nicolas Rijo  2 , Céline Dugourd  2 , Nadir Saoudi  2
Affiliations
Controlled Clinical Trial

Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

Abdelkarim Errahmouni et al. Europace. 2015 Jul.

Abstract

Aims: The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation.

Methods and results: Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN-RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN-CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027).

Conclusion: The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced.

Keywords: Atrial fibrillation; Catheter ablation; Magnetic navigation; Robotic sheath.

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Figures

Figure 1
Figure 1
The robotic deflectable sheath (V-CAS Deflect) fully undeflected (left panel) and fully deflected (right panel).
Figure 2
Figure 2
A loop with the robotic sheath in the LA was systematically used for targeting the ostia of the right PVs: (A) antero-posterior fluoroscopic image; (B) map of the LA; and (C) merge with the computed tomographic scan reconstruction of the LA.
Figure 3
Figure 3
Final setup of the catheter-only advancement system with a fixed curve sheath.
Figure 4
Figure 4
(A) Final setup of the arms of the V-Drive Duo (with V-CAS Deflect and V-Loop) at the sheath insertion site. (B) The V-Drive controller that allows remote manipulation of the ablation catheter, its sheath and of the lasso.
Figure 5
Figure 5
Kaplan–Meier curves of arrhythmia-free survival during the follow-up after the initial procedure. Robotic sheath use was associated with significant reduction of atrial fibrillation recurrence.
See this image and copyright information in PMC

References

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