Khairy Paul, Dyrda Katia, Mondésert Blandine, Aguilar Martin, Dubuc Marc, Cadrin-Tourigny Julia, Guerra Peter G, Raymond-Paquin Alexandre, Rivard Léna, Tadros Rafik, Talajic Mario, Thibault Bernard, Macle Laurent, Roy Denis
Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada.
J Clin Med. 2024 Sep 13;13(18):5432. doi: 10.3390/jcm13185432.
The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly impact quality of life, hospitalizations, and mortality. Catheter ablation has gained widespread acceptance as a critical intervention for managing arrhythmias in patients with CHD. However, anatomical and physiological features unique to this population pose challenges to standard manual ablation procedures, potentially impacting safety and efficacy. Robotic magnetic-guided navigation (RMN) has emerged as a technological solution to address these challenges. By utilizing soft and flexible catheters equipped with magnets at their tips, RMN enables robotic steering and orientation of catheters in three-dimensional space. This technology overcomes obstacles such as distorted vascular pathways and complex post-surgical reconstructions to facilitate access to target chambers and improve maneuverability within the heart. In this review, we present an overview of the safety and efficacy evidence for RMN-guided catheter ablation in CHD patients and highlight potential advantages. Additionally, we provide a detailed case presentation illustrating the practical application of RMN technology in this population. Although the literature on RMN-guided ablation in patients with CHD remains limited, it has shown promise in achieving successful outcomes, particularly in cases where manual ablation failed or was deemed non-feasible. Further validation through large-scale prospective studies is necessary to fully ascertain the benefits of RMN technology in this patient population.
近几十年来，由于死亡率大幅下降，先天性心脏病（CHD）的患病率激增。随着先天性心脏病患者年龄的增长，他们越来越容易出现包括心律失常在内的晚期并发症。这些心律失常通常在手术干预数十年后出现，对生活质量、住院率和死亡率产生重大影响。导管消融作为治疗先天性心脏病患者心律失常的关键干预措施已得到广泛认可。然而，该人群独特的解剖和生理特征给标准的手动消融手术带来了挑战，可能会影响安全性和有效性。机器人磁导航（RMN）作为一种技术解决方案应运而生，以应对这些挑战。通过使用尖端装有磁铁的柔软灵活导管，RMN能够在三维空间中对导管进行机器人操纵和定向。这项技术克服了血管路径扭曲和复杂的术后重建等障碍，便于进入目标腔室并提高心脏内的可操作性。在本综述中，我们概述了RMN引导下导管消融治疗先天性心脏病患者的安全性和有效性证据，并强调了潜在优势。此外，我们提供了一个详细的病例介绍，说明RMN技术在该人群中的实际应用。尽管关于RMN引导下先天性心脏病患者消融治疗的文献仍然有限，但它已显示出取得成功结果的前景，特别是在手动消融失败或被认为不可行的情况下。需要通过大规模前瞻性研究进行进一步验证，以充分确定RMN技术在该患者群体中的益处。
