Left Atrial Isthmus Line Ablation Using a Remote Robotic Navigation System: Feasibility, Efficacy and Long-term Outcome

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2013 Jul 31

PMID 23896973

Citations 7

Authors

Andreas Rillig

Boris Schmidt

Britta Feige

Erik Wissner

Andreas Metzner

Anita Arya

Shibu Mathew

Hisaki Makimoto

Peter Wohlmuth

Feifan Ouyang

Karl-Heinz Kuck

Roland Richard Tilz

Affiliations

Soon will be listed here.

Abstract

Background: Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists.

Methods And Results: In this pilot study, CPVI combined with LAI-ablation were performed using a RNS and 3D-mapping system in 42 patients with persistent (n = 24, 57.1 %) or longstanding persistent AF. Ablation was performed using either a 3.5 mm irrigated tip catheter (ITC) with 6 (group-A, n = 16; max. 40 W, contact force 10-40 g) or (after a steam pop occurred in one patient) with a 4 mm ITC with 12 irrigation holes (group-B, n = 26; max. 30 W, contact force 10-30 g). Epicardial ablation was performed manually whenever bidirectional LAI-block could not be obtained with a maximum of 20 endocardial RF-applications. LAI-conduction block was achieved in all patients using RNS; in six patients (14.3 %), additional epicardial ablation was required to achieve LAI-block. A steam pop occurred during LAI-ablation resulting in cardiac tamponade in one patient in group-A. After a median follow-up period of 21 months, arrhythmia recurrence was seen in in 23/42 patients (18 patients with AF and 5 patients with atrial tachycardia) and repeat procedure was performed in 12 (28.6 %) patients; recovered LAI-conduction was found in 5/12 (41.7 %) patients. The RNS-group was compared to a historical group of 20 patients with manual LAI-ablation. Using RNS, LAI-block was more often achieved (42 (100 %) vs 16 (80 %), p < 0.01) and epicardial ablation was required in a significantly smaller number of patients (6 (14.3) vs 10 (50 %), p < 0.01).

Conclusions: LAI-ablation using RNS appears to be feasible in all patients. At repeat procedure, LAI-conduction can frequently occur; power and contact-force adaption appears to be mandatory to reduce the risk of complications. Using RNS, instead of a manual approach for LAI-line ablation may facilitate creation of a bidirectional LAI-block.

Citing Articles

[Electrical isolation of the left atrial appendage : Benefits and risks].

Bellmann B, Tilz R, Rillig A Herz. 2017; 42(4):364-372.

PMID: 28357448 DOI: 10.1007/s00059-017-4559-0.

Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation.

Rillig A, Lin T, Schmidt B, Feige B, Heeger C, Wegner J Clin Res Cardiol. 2015; 105(2):106-16.

PMID: 26199066 DOI: 10.1007/s00392-015-0892-6.

Comparison of contact force-guided procedure with non-contact force-guided procedure during left atrial mapping and pulmonary vein isolation: impact of contact force on recurrence of atrial fibrillation.

Makimoto H, Heeger C, Lin T, Rillig A, Metzner A, Wissner E Clin Res Cardiol. 2015; 104(10):861-70.

PMID: 25893569 DOI: 10.1007/s00392-015-0855-y.

Atrial fibrillation and long-term sports practice: epidemiology and mechanisms.

Wernhart S, Halle M Clin Res Cardiol. 2014; 104(5):369-79.

PMID: 25539701 DOI: 10.1007/s00392-014-0805-0.

Remote magnetic navigation for persistent atrial fibrillation ablation via a retrograde aortic access: an approach for patients after atrial septal defect device closure.

Buiatti A, Hessling G, Semmler V, Ammar S Clin Res Cardiol. 2014; 103(12):1028-30.

PMID: 25085268 DOI: 10.1007/s00392-014-0747-6.

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