CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
AFRICA
e11
contact force. This technology has also been used to improve
safety by generating tactile feedback to the Instinctive motion
controller used for remote navigation of the catheter. Intellisense
Fine Force measurements are displayed graphically and above a
set threshold transmitted as warning vibrations to the Instinctive
motion controller used to remotely manipulate the Lynx
TM
catheter.
Despite the acute angulation of the robotic catheter inherent
in the trans-septal trans-mitral approach, we found contact-force
measurements to be useful, although frequent re-baselining was
required to maintain stable measurements. This was not the case
when the Artisan catheter was used in the ventricles.
2
This may
be because of the enhanced flexibility of the Lynx
TM
catheter.
The impact of robotic technology on the comfort of the
operator cannot be underestimated. Reduced operator fatigue
probably results in improved decision making and procedural
efficiency and safety. Importantly, X-ray exposure to the operator
was negligible since catheter manipulation was remotely
performed.
Two remote robotic catheter manipulation technologies
are currently available, a robotically controlled sheath system
(Hansen) and a magnetic navigation system (Stereotaxis). We
opted for the Hansen system because of the ease of installation
and the small footprint of the device. No additional alterations to
the cardiac catheterisation facility are reqired.
The magnetic system requires reinforcement of the floor due
to the weight of the large magnets and the walls require shielding
to limit the effects of the magnetic field. Furthermore, at the
time when we opted to purchase a robotic system, there were
unresolved technical issues with the cooling of the magnetic
catheter. A second-generation cooled magnetic catheter has since
been released.
Our patient was clearly a candidate for an implantable
cardioverter defibrillator (ICD) since he had significantly reduced
LV ejection fraction and monomorphic haemodynamically
significant VT. Resynchronisation therapy was not indicated as
QRS duration was less than 150 ms in sinus rhythm.
The role of device therapy in this setting with particular
reference to the impact on mortality was discussed in considerable
detail. The negative impact of shocks on quality of life was cited
by the patient and family as an important reason to defer device
implant. A son and daughter of the patient are medical doctors so
they were well informed. It was agreed that an ICD would only
be implanted if ablation failed to control symptoms, in which
case the objective was to use anti-tachycardia pacing to terminate
VT (with shock therapy as a last resort).
Conclusion
We describe the first robotically assisted RF ablation of
ischaemic VT in the world, using a novel integrated RF ablation
catheter and robotic sheath with a reduced profile and enhanced
flexibility.
References
1.
Koa-Wing M, Linton NWF, Kojodjojo P, O’ Neill MD, Peters NS,
Davies W, Kanagaratnam P. Robotic catheter ablation of ventricular
tachycardia in a patient with congenital heart disease and Rastelli repair.
J Cardiovasc Electrophysiol
2009;
20
(10): 1163–1166.
2.
Valderrábano M, Dave AS, Báez-Escudero JL, Rami T. Robotic catheter
ablation of ventricular tachycardia: initial experience.
Heart Rhythm
2011;
8
: 1837–1846.
3.
Di Biase L, Gallinghouse J, Rajappan K, Schilling R, Kautzner J,
Mohanty P,
et al.
Preliminary acute results of robotic catheter abla-
tion of atrial fibrillation utilizing the Lynx robotic catheter system
in humans: safety and feasibility.
J Cardiovasc Electrophysiol
2011;
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