Malcolme-Lawes L, Kanagaratnam P
Imperial College Healthcare London, London, UK.
Minerva Cardioangiol. 2010 Dec;58(6):691-9.
Robotic technologies have been developed to allow optimal catheter stability and reproducible catheter movements with the aim of achieving contiguous and transmural lesion delivery. Two systems for remote navigation of catheters within the heart have been developed; the first is based on a magnetic navigation system (MNS) Niobe, Stereotaxis, Saint-Louis, Missouri, USA, the second is based on a steerable sheath system (Sensei, Hansen Medical, Mountain View, CA, USA). Both robotic and magnetic navigation systems have proven to be feasible for performing ablation of both simple and complex arrhythmias, particularly atrial fibrillation. Studies to date have shown similar success rates for AF ablation compared to that of manual ablation, with many groups finding a reduction in fluoroscopy times. However, the early learning curve of cases demonstrated longer procedure times, mainly due to additional setup times. With centres performing increasing numbers of robotic ablations and the introduction of a pressure monitoring system, lower power settings and instinctive driving software, complication rates are reducing, and fluoroscopy times have been lower than manual ablation in many studies. As the demand for catheter ablation for arrhythmias such as atrial fibrillation increases and the number of centres performing these ablations increases, the demand for systems which reduce the hand skill requirement and improve the comfort of the operator will also increase.
已经开发了机器人技术，以实现最佳的导管稳定性和可重复的导管移动，目的是实现连续和透壁的病变传递。已经开发了两种用于心脏内导管远程导航的系统；第一种基于磁导航系统（MNS）Niobe（美国密苏里州圣路易斯市的Stereotaxis公司），第二种基于可操纵鞘管系统（美国加利福尼亚州山景城的Hansen Medical公司的Sensei）。机器人和磁导航系统都已被证明对于进行简单和复杂心律失常（特别是心房颤动）的消融是可行的。迄今为止的研究表明，与手动消融相比，房颤消融的成功率相似，许多研究小组发现透视时间有所减少。然而，早期病例的学习曲线显示手术时间更长，主要是由于额外的设置时间。随着进行机器人消融的中心数量增加以及压力监测系统、更低功率设置和直观驱动软件的引入，并发症发生率正在降低，并且在许多研究中透视时间已低于手动消融。随着对诸如心房颤动等心律失常的导管消融需求增加以及进行这些消融的中心数量增加，对降低手工操作技能要求并提高操作者舒适度的系统的需求也将增加。
