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Herz
Herz
Urban & Vogel 2008
Urban & Vogel 2008
1 Department of Medicine II, Cardiology, Asklepios KlinikSt. Georg, Hamburg, Germany.
Catheter Ablation New Developments in Robotics
K.R. Julian Chun, Boris Schmidt, Blent Kktrk, Roland Tilz, Alexander Frnkranz, Melanie Konstantinidou, Erik Wissner, Andreas Metzner, Feifan Ouyang, Karl-Heinz Kuck1
Key Words: Catheter ablation Robotic navigation Atrial fibrillation
Abstract
Catheter ablation has become the curative treatment modality for various arrhythmias. Extending the indications for catheter ablation from simple supraventricular tachycardias to complex arrhythmias such as ventricular tachycardia or atrial fibrillation, the investigator faces prolonged procedure times, fluoroscopy
exposure and the need for stable and reproducible catheter movement. Recently, remote-controlled robotic catheter ablation has emerged as a novel ablation concept to meet these requirements. This review describes the two available robotic ablation systems and summarizes their clinical applications and current human experience.
Herz 2008;33:5869
DOI 10.1007/ s00059-008-3180-7
Katheterablation Neuentwicklungen robotischer Systeme
Schlsselwrter: Katheterablation Robotische Navigation Vorhofflimmern
Zusammenfassung
Die Indikationstellung zur Katheterablation hat sich von einfachen supraventrikulren Tachykardien hin zu komplexen Herzrythmusstrungen wie ventrikulren Tachykardien und Vorhofflimmern erweitert. Der Untersucher ist dabei allerdings langen Prozedurzeiten, hohen Durchleuchtungszeiten und der Anforderung einer sta-
bilen und reproduzierbaren Katheterfhrung ausgesetzt. Die Neuentwicklung ferngesteuerter robotischer Ablationssysteme kann diesen Anforderungen mglicherweise gerecht werden. Diese bersicht beschreibt das technische Prinzip beider derzeit verfgbaren robotischen Ablationssysteme und fasst ihre klinischen Anwendungen und Erfahrungen zusammen.
Introduction
Catheter ablation of various arrhythmias has been established as a highly successful treatment strategy. Over the recent years, catheter ablation has transitioned from simple focal ablation for supraventricular tachycardias [1] to linear lesion deployments in complex three-dimensional (3-D) anatomy for the treatment of arrhythmias such as atrial fibrillation (AF) [2]. Targeting complex arrhythmias, optimal catheter stability and reproducible catheter movements of a highly skilled investigator are required in order to achieve contiguous linear lesions. Partial automation of the procedure is expected to improve reproducibility of procedural endpoints, eventually resulting in reduced learning curves for the investigator. By contrast, manual ablation of complex arrhythmias can often be achieved only in conjunction with a 3-D reconstruction system as well as prolonged procedure time and fluoroscopy exposure for both the patient and the investigator. While this may be a single event for the patient, the investigator is facing daily multiple strenuous ablation procedures and,...