Remote Magnetic Navigation. Human Experience in Pulmonary Vein Ablation

Luigi Di Biase, Tamer S. Fahmy, Dimpi Patel, Rong Bai, Kenneth Civello, Oussama M. Wazni, Mohamed Kanj, Claude S. Elayi, Chi Keong Ching, Mohamed Khan, Lucie Popova, Robert A. Schweikert, Jennifer E. Cummings, J. David Burkhardt, David O. Martin, Mandeep Bhargava, Thomas Dresing, Walid Saliba, Mauricio Arruda, Andrea Natale

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Objectives: We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF). Background: This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill. Methods: After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs). Results: Using the coordinate approach, the target location was reached in only 60% of the sites, whereas by using the wand approach 100% of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8%) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33%) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 ± 2 months, recurrence was seen in 5 patients (22%) with complete PVAI and in 20 patients (90%) with incomplete PVAI. Conclusions: Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.

Original languageEnglish (US)
Pages (from-to)868-874
Number of pages7
JournalJournal of the American College of Cardiology
Volume50
Issue number9
DOIs
StatePublished - Aug 28 2007
Externally publishedYes

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Pulmonary Veins
Atrial Fibrillation
Catheters
Catheter Ablation
Patient Rights
Technology
Recurrence

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Remote Magnetic Navigation. Human Experience in Pulmonary Vein Ablation. / Di Biase, Luigi; Fahmy, Tamer S.; Patel, Dimpi; Bai, Rong; Civello, Kenneth; Wazni, Oussama M.; Kanj, Mohamed; Elayi, Claude S.; Ching, Chi Keong; Khan, Mohamed; Popova, Lucie; Schweikert, Robert A.; Cummings, Jennifer E.; Burkhardt, J. David; Martin, David O.; Bhargava, Mandeep; Dresing, Thomas; Saliba, Walid; Arruda, Mauricio; Natale, Andrea.

In: Journal of the American College of Cardiology, Vol. 50, No. 9, 28.08.2007, p. 868-874.

Research output: Contribution to journalArticle

Di Biase, L, Fahmy, TS, Patel, D, Bai, R, Civello, K, Wazni, OM, Kanj, M, Elayi, CS, Ching, CK, Khan, M, Popova, L, Schweikert, RA, Cummings, JE, Burkhardt, JD, Martin, DO, Bhargava, M, Dresing, T, Saliba, W, Arruda, M & Natale, A 2007, 'Remote Magnetic Navigation. Human Experience in Pulmonary Vein Ablation', Journal of the American College of Cardiology, vol. 50, no. 9, pp. 868-874. https://doi.org/10.1016/j.jacc.2007.05.023
Di Biase, Luigi ; Fahmy, Tamer S. ; Patel, Dimpi ; Bai, Rong ; Civello, Kenneth ; Wazni, Oussama M. ; Kanj, Mohamed ; Elayi, Claude S. ; Ching, Chi Keong ; Khan, Mohamed ; Popova, Lucie ; Schweikert, Robert A. ; Cummings, Jennifer E. ; Burkhardt, J. David ; Martin, David O. ; Bhargava, Mandeep ; Dresing, Thomas ; Saliba, Walid ; Arruda, Mauricio ; Natale, Andrea. / Remote Magnetic Navigation. Human Experience in Pulmonary Vein Ablation. In: Journal of the American College of Cardiology. 2007 ; Vol. 50, No. 9. pp. 868-874.
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abstract = "Objectives: We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF). Background: This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill. Methods: After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs). Results: Using the coordinate approach, the target location was reached in only 60{\%} of the sites, whereas by using the wand approach 100{\%} of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8{\%}) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33{\%}) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 ± 2 months, recurrence was seen in 5 patients (22{\%}) with complete PVAI and in 20 patients (90{\%}) with incomplete PVAI. Conclusions: Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.",
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T1 - Remote Magnetic Navigation. Human Experience in Pulmonary Vein Ablation

AU - Di Biase, Luigi

AU - Fahmy, Tamer S.

AU - Patel, Dimpi

AU - Bai, Rong

AU - Civello, Kenneth

AU - Wazni, Oussama M.

AU - Kanj, Mohamed

AU - Elayi, Claude S.

AU - Ching, Chi Keong

AU - Khan, Mohamed

AU - Popova, Lucie

AU - Schweikert, Robert A.

AU - Cummings, Jennifer E.

AU - Burkhardt, J. David

AU - Martin, David O.

AU - Bhargava, Mandeep

AU - Dresing, Thomas

AU - Saliba, Walid

AU - Arruda, Mauricio

AU - Natale, Andrea

PY - 2007/8/28

Y1 - 2007/8/28

N2 - Objectives: We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF). Background: This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill. Methods: After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs). Results: Using the coordinate approach, the target location was reached in only 60% of the sites, whereas by using the wand approach 100% of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8%) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33%) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 ± 2 months, recurrence was seen in 5 patients (22%) with complete PVAI and in 20 patients (90%) with incomplete PVAI. Conclusions: Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.

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