Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas 77030, USA.
Heart Rhythm. 2011 Dec;8(12):1837-46. doi: 10.1016/j.hrthm.2011.07.032. Epub 2011 Jul 28.
Catheter ablation of ventricular tachycardia (VT) can be technically challenging due to difficulty with catheter positioning in the left ventricle (LV) and achieving stable contact. The Hansen Sensei Robotic system (HRS) has been used in atrial fibrillation but its utility in VT is unclear.
The purpose of this study was to test the technical feasibility of robotic catheter ablation of LV ventricular tachycardia (VT) using the HRS.
Twenty-three patients underwent LV VT mapping and ablation with the HRS via a transseptal, transmitral valve approach. Nineteen patients underwent substrate mapping and ablation (18 had ischemic cardiomyopathy, 1 had an apical variant of hypertrophic cardiomyopathy). Four patients had focal VT requiring LV VT mapping and ablation. Procedural endpoints included substrate modification by endocardial scar border ablation and elimination of late potentials, or elimination of inducible focal VT.
Mapping and ablation were entirely robotic without requiring manual catheter manipulation in all patients and reaching all LV regions with stable contact. Fluoroscopy time of the LV procedure was 22.2 ± 11.2 minutes. Radiofrequency time was 33 ± 21 minutes. Total procedural times were 231 ± 76 minutes. Complications included a left groin hematoma (opposite to the HRS sheath), 1 pericardial effusion without tamponade that was drained successfully, and transient right ventricular failure in a patient with previous left ventricular assist device. At 13.4 ± 6.7 months of follow-up (range 1-19 months), recurrence of VT occurred in 3 of 23 patients.
Our initial experience suggests that the HRS allows successful mapping and ablation of LV VT.
由于左心室（LV）中导管定位困难且难以实现稳定接触，因此，对室性心动过速（VT）进行导管消融在技术上具有挑战性。Hansen Sensei 机器人系统（HRS）已用于治疗心房颤动，但在 VT 中的应用尚不清楚。
本研究旨在测试使用 HRS 对 LV 室性心动过速（VT）进行机器人导管消融的技术可行性。
23 例患者经房间隔、经二尖瓣途径行 LV VT 标测和消融。19 例患者行基质标测和消融（18 例为缺血性心肌病，1 例为心尖肥厚型心肌病变异型）。4 例患者有局灶性 VT，需行 LV VT 标测和消融。程序终点包括通过心内膜瘢痕边界消融和消除晚期电位或消除可诱导的局灶性 VT 来改变基质。
所有患者均无需手动导管操作即可完全进行机器人标测和消融，且可稳定接触到所有 LV 区域。LV 手术的透视时间为 22.2±11.2 分钟。射频时间为 33±21 分钟。总手术时间为 231±76 分钟。并发症包括左腹股沟血肿（与 HRS 鞘相反）、1 例心包积液无填塞且成功引流，以及 1 例既往左心室辅助装置的患者出现短暂性右心室衰竭。在 13.4±6.7 个月的随访中（1-19 个月），23 例患者中有 3 例复发 VT。
我们的初步经验表明，HRS 可成功对 LV VT 进行标测和消融。
