Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
J Cardiovasc Electrophysiol. 2011 May;22(5):534-40. doi: 10.1111/j.1540-8167.2010.01942.x. Epub 2010 Nov 23.
Remote navigation systems represent a novel strategy for catheter ablation of atrial fibrillation (AF). The goal of this study is to describe a single-center experience with the electromechanical robotic system (Sensei, Hansen Medical) in treatment of patients with paroxysmal AF.
Out of 200 patients who underwent robotically guided ablation for AF between 2007 and 2009 at our institute, 100 patients (29 women, age 56.5 ± 10 years) had paroxysmal AF refractory to antiarrhythmic drugs. Electroanatomic mapping using NavX system (St. Jude Medical) provided anatomical shell for subsequent circumferential ablation with robotic catheter (Artisan) loaded with a 3.5-mm, open-irrigation, cooled-tip ablation catheter.
A mean of 69 radiofrequency current applications (duration 2082 ± 812 seconds) were delivered to achieve circumferential electrical isolation of pulmonary venous antra. Total procedural time reached 222 ± 54 minutes. The mean fluoroscopic time was 11.9 ± 7.8 minutes. There were no major procedure-related complications. After a median follow-up of 15 months (range 3-28 months), 63% of the patients were free from any atrial arrhythmias ≥ 30 seconds after the single procedure. Success rate increased to 86% after 1.2 procedures. Multivariate analysis revealed that only predictor of recurrent AF/AT was shorter overall procedural time (207 ± 36 vs 236 ± 64 minutes in patients with and without recurrences, respectively, P = 0.0068).
This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow-up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium.
远程导航系统代表了一种治疗心房颤动（AF）的新策略。本研究的目的是描述在我们的研究所中，使用机电机器人系统（Sensei，Hansen Medical）治疗阵发性 AF 患者的单中心经验。
在 2007 年至 2009 年期间，我院共有 200 例患者接受机器人引导消融治疗 AF，其中 100 例（29 例女性，年龄 56.5 ± 10 岁）为对抗心律失常药物无效的阵发性 AF。使用 NavX 系统（圣犹达医疗）进行电解剖映射，为随后使用机器人导管（Artisan）进行环形消融提供解剖外壳，该机器人导管装载有 3.5 毫米、开放式灌流、冷却尖端消融导管。
平均进行 69 次射频电流应用（持续时间 2082 ± 812 秒），以实现肺静脉入口的环形电隔离。总手术时间达到 222 ± 54 分钟。平均透视时间为 11.9 ± 7.8 分钟。无重大手术相关并发症。中位随访 15 个月（范围 3-28 个月）后，单次手术 30 秒以上无任何房性心律失常的患者比例为 63%。1.2 次手术后成功率增加至 86%。多变量分析显示，只有总手术时间较短（分别为 207 ± 36 分钟和 236 ± 64 分钟，P = 0.0068）是复发性 AF/AT 的唯一预测因素。
本研究证明了机器人导航在阵发性 AF 导管消融中的可行性和安全性。中期随访证明了该技术的成功率与其他技术相当，并且有可能在更广泛的消融中取得进展，沿着心肌较厚的嵴进行消融。
