Robotic ablation in electrophysiology

Catheter ablation has gone through great improvement recent years and it has become a well-established therapeutic treatment for various arrhythmias. Cardiac robotic systems became more important in clinical electrophysiology and have several advantages over manual catheter ablation. The Stereotaxis Niobe Magnetic Navigation System (RMN) consists of two permanent external magnets that generate a magnetic field and allows the operator to manipulate the catheter tip. It provides unrestricted catheter movements with enhanced stability. The RMN significantly decreases the use of fluoroscopy for both patient and physician and allows safe procedures with no risk of acute perforation. Studies reveal that comparable success rates are obtained using RMN in treatment of atrial arrhythmias, AV nodal reentrant tachycardias, circus movement tachycardias, and ventricular tachycardias. Another robotic system is the Hansen Sensei Robotic System (HSRS) that provides improved positioning and control of the catheters within the heart. The HSRS consists of a remote catheter manipulator that allows for three-dimensional motion in response to the operator's hand motion. An estimation can be made of the applied force and therefore of lesion formation. It decreases the use of fluoroscopy and the operator's exposure can be reduced by 77 % when using HSRS. In atrial fibrillation similar efficacy was achieved using HSRS when compared to conventional methods. However, when we evaluate robotic technology, we must conclude that it creates a less efficient workflow and specially designed hardware and catheters are required for the procedures. Nevertheless, these technologies are able to increase safety and efficacy of ablation procedures.

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