Remote Catheter Navigation

Abstract

Percutaneous catheter ablation has emerged as a promising curative modality for the treatment of atrial fibrillation (AF). However, the safety and success of this procedure are operator dependent and require precise catheter manipulation and stable contact during ablation. Remote catheter navigation has the potential to remove some of the barriers traditionally associated with percutaneous catheter ablation, such as the need for manual dexterity and long radiation exposure times, thus enabling more physicians to perform these procedures. Initial experience with the remote magnetic navigation system (MNS) shows the safety and feasibility of mapping and ablation of various arrhythmias, including successful ablation of AV Nodal Re-entrant Tachycardia (AVNRT), atrial flutter, and fibrillation as well as ventricular tachycardia. An initial learning curve is suggested, with eventual benefits including decrease in fluoroscopy and ablation time, mainly related to those hard to reach areas. Remote robotic navigation has been assessed predominantly for atrial ablation. In a preclinical animal study, target sites were accurately attained, and radio-frequency (RF) ablation was performed with no complications in both atria. In human trials, remote robotic navigation was shown to be safe and effective for mapping and ablation of atrial fibrillation and flutter as well as atrioventricular (AV) nodal reentrant tachycardias. These preliminary results regarding remote catheter navigation appear promising. Their added advantage over the current conventional approach in terms of improving the success rate while minimizing risk for both the patient and the operator remain to be proven in large-scale clinical trials.