CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
280
AFRICA
which require a lower infusion rate (8 ml/min) due to design
changes, producing more efficient cooling, will reduce the
likelihood of post-procedural pericardial effusion or congestive
heart failure. Lastly, the smaller size of the new Lynx catheter
will significantly reduce the risk of minor complications such as
groin haematoma or meralgia paresthetica.
It is important to note that despite our modified post-ablation
anticoagulation regimen, which differs substantially from the
international guidelines due to poor patient compliance with
anticoagulation on warfarin and INR testing, no case of transient
ischaemic attack or stroke was reported in the median nine-
month post-ablation period. Physicians who care for similar
types of patients in areas where compliance is an issue may find
our modifications to the standard post-ablation anticoagulation
regimen helpful.
The main limitations of this study are the fact that it lacked a
matched control group with manual ablation and that there were
relatively few subjects in the paroxysmal and long-standing
persistent AF groups. Furthermore, some of the therapeutic
modifications presented in this article, mainly the modified
post-ablation anticoagulation regimen, were based on clinical
experience and characteristics of our specific patient population
and are not in conformity with international guidelines. Hence,
we do not propose that our methods be adopted by other centres.
As a real-world study, we were treating symptomatic patients,
with the main clinical endpoint being relief of symptoms. We
were not able to confirm the absence of asymptomatic recurrence
of AF without ECG Holter monitoring. Nevertheless, we believe
that the safety and mid-term efficacy results of this study may
provide valuable insights for the daily practice of medicine.
Conclusion
The Sensei™ robotic navigation system offers a safe and
effective approach for the treatment of AF. Its efficacy in
patients with persistent AF is encouraging. Its overall success
rate is comparable to manual techniques and impressive for a
treatment approach that is relatively in its infancy. There is a
learning curve with regard to fluoroscopy and procedure times,
after which point reduction in radiation exposure and operator
strain, as well as improvement in procedure throughputs are
even more pronounced. Lynx™ as well as the newer generation
of ablation catheters compatible with the Sensei™ system offer
operators the possibility of even safer procedures with lower
risks for complications.
We acknowledge the anaesthetists, Drs Dirk Lilienfeld, Adi Smit, Claire
Zondagh and Rene Verbeek, who worked on the patients.
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