Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Sep 27:11:1431396.
doi: 10.3389/fcvm.2024.1431396. eCollection 2024.

Best practices in robotic magnetic navigation-guided catheter ablation of cardiac arrhythmias, a position paper of the Society for Cardiac Robotic Navigation

Anna M E Noten #  1 , Tamas Szili-Torok #  2 , Sabine Ernst  3 , David Burkhardt  4 , Diogo Cavaco  5 , Xu Chen  6 , Jim W Cheung  7 , Christian de Chillou  8 , Eugene Crystal  9 , Daniel H Cooper  10 , Maurizio Gasparini  11 , Tamas Geczy  12 , Konrad Goehl  13 , Burkhard Hügl  14 , Qi Jin  15 , Priit Kampus  16 , Pedram Kazemian  17 , Muchtiar Khan  18 , Ole Kongstad  19 , Jarkko Magga  20 , Darren Peress  21 , Pekka Raatikainen  22 , Alexander Romanov  23 , Ole Rossvoll  24 , Gurjit Singh  25 , Radu Vatasescu  26 , Sip Wijchers  1 , Kohei Yamashiro  27 , Sing-Chien Yap  1 , J Peter Weiss  28
Affiliations
Review

Best practices in robotic magnetic navigation-guided catheter ablation of cardiac arrhythmias, a position paper of the Society for Cardiac Robotic Navigation

Anna M E Noten et al. Front Cardiovasc Med. .

Abstract

Preamble: Robotic magnetic navigation (RMN)-guided catheter ablation (CA) technology has been used for the treatment of cardiac arrhythmias for almost 20 years. Various studies reported that RMN allows for high catheter stability, improved lesion formation and a superior safety profile. So far, no guidelines or recommendations on RMN-guided CA have been published.

Purpose: The aim of this consensus paper was to summarize knowledge and provide recommendations on management of arrhythmias using RMN-guided CA as treatment of atrial fibrillation (AF) and ventricular arrhythmias (VA).

Methodology: An expert writing group, performed a detailed review of available literature, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Recommendations on RMN-guided CA are presented in a guideline format with three levels of recommendations to serve as a reference for best practices in RMN procedures. Each recommendation is accompanied by supportive text and references. The various sections cover the practical spectrum from system and patient set-up, EP laboratory staffing, combination of RMN with fluoroscopy and mapping systems, use of automation features and ablation settings and targets, for different cardiac arrhythmias.

Conclusion: This manuscript, presenting the combined experience of expert robotic users and knowledge from the available literature, offers a unique resource for providers interested in the use of RMN in the treatment of cardiac arrhythmias.

Keywords: atrial fibrillation; catheter ablation; premature ventricular beat; remote magnetic navigation; robotic magnetic navigation; robotic navigation; ventricular arrhythmia; ventricular tachycardia.

PubMed Disclaimer

Conflict of interest statement

The Erasmus MC has received research grants from Acutus Medical, Biosense Webster and Stereotaxis. TS-T has received an educational grant from Abbott, a contract for education and advisory activities with Biotronik and consultancy contract with Acutus Medical and Ablacon. SW has received honoraria from Biotronik en Daiichi Sankyo. S-CY has received a research grant from Medtronic and honoraria from Medtronic and Boston Scientific. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The RMN system. This figure illustrates the RMN Stereotaxis Genesis system hardware. The operation table and fluoroscopy system are present as they are in conventional invasive cardiology procedure labs. In addition, two external magnets are positioned alongside the patient which provide a magnetic field of 0.08–0.10 T. The magnetic vector is altered by the operator from the computer in the control room.
Figure 2
Figure 2
Image integration. This figure shows the various screen outputs which are displayed in real-time to the operator during a RMN-guided ablation procedure utilizing image integration in a patient after congenital heart surgery. This patient had a single ventricle physiology, with a small RV, large ventricular septal defect and double inlet left ventricle with two AV valves. The patient previously underwent total cavo-pulmonary connection (TCPC) and the remaining RA is rather small. The upper panels show segmented 3D CMR scan images overlayed on the fluoroscopy images. The RMN magnetic vector is displayed as yellow arrow and the ablation catheter is also visualized. The middle panels show the CARTO bipolar voltage maps in two directions of the ventricle together with the RMN magnetic vector (yellow arrow) and the ablation catheter (retrograde approach). The native chambers have normal voltage, whereas the TCPC is large and has scar and that is where reentry was observed and atrial tachycardia originated. The left lower panel visualizes the applied therapy using the Ablation History feature's output on the activation map. The applied therapy is displayed in yellow-orange (see Figure 3 for a more detailed explanation). The right lower panel provides the so called Ablation History graph visualizing the applied energy. The various imaging modalities displayed are all fully integrated with the RMN system.
Figure 3
Figure 3
The ablation history feature. This figure illustrates the Ablation History of a patient who underwent pulmonary vein isolation. The pulmonary veins were isolated by applying two Wide Area Circumferential Ablation (WACA) lines around the left-sided and right-sided pulmonary veins. The main panel represent the CARTO screen, on which the LA FAM map is displayed and made transparent. The applied energy during ablation is visualized 3-dimensionally from yellow to orange based on the applied Watt-Seconds per location. In this case, the ablation catheter is in optimal contact with myocardial tissue, which is evaluated by the e-Contact Module and displayed real-time to the user with a dense blue starburst at the catheter tip.
See this image and copyright information in PMC

References

    1. Faddis MN, Blume W, Finney J, Hall A, Rauch J, Sell J, et al. Novel, magnetically guided catheter for endocardial mapping and radiofrequency catheter ablation. Circulation. (2002) 106(23):2980–5. 10.1161/01.CIR.0000038704.84304.6F - DOI - PubMed
    1. Faddis MN, Chen J, Osborn J, Talcott M, Cain ME, Lindsay BD. Magnetic guidance system for cardiac electrophysiology: a prospective trial of safety and efficacy in humans. J Am Coll Cardiol. (2003) 42(11):1952–8. 10.1016/j.jacc.2003.07.023 - DOI - PubMed
    1. Ernst S, Ouyang F, Linder C, Hertting K, Stahl F, Chun J, et al. Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation. Circulation. (2004) 109(12):1472–5. 10.1161/01.CIR.0000125126.83579.1B - DOI - PubMed
    1. Bhaskaran A, Barry MA, Al Raisi SI, Chik W, Nguyen DT, Pouliopoulos J, et al. Magnetic guidance versus manual control: comparison of radiofrequency lesion dimensions and evaluation of the effect of heart wall motion in a myocardial phantom. J Interv Card Electrophysiol. (2015) 44(1):1–8. 10.1007/s10840-015-0023-3 - DOI - PubMed
    1. Jia K, Jin Q, Liu A, Wu L. Remote magnetic navigation versus manual control navigation for atrial fibrillation ablation: a systematic review and meta-analysis. J Electrocardiol. (2019) 55:78–86. 10.1016/j.jelectrocard.2019.05.001 - DOI - PubMed

LinkOut - more resources