Robotic Technology is Changing the Paradigm for Catheter Ablation Treatment of Atrial Fibrillation
Feburary 19, 2010 5:32 AM CT
By: Deborah Brauser
Boston – In one of the final sessions at the Boston Atrial Symposium 2010, Dr. Andrea Natale (Texas Cardiac Arrhythmia Institute, Austin, TX) discussed the current status of robotic technology for ablations, including new robotic catheter systems with steerable guide catheters and steerable sheaths.
In a study published in December, his investigational group compared ablations using robotic catheter navigation using the Hansen Robotic System to manual navigation. “We examined 390 patients, making this the largest single center experience so far,” reported Dr. Natale. They found that although the success rate was statistically the same in both groups, the trend was higher for the robotic process (85% vs. 81% with drugs, respectively; 78% vs. 74% off drugs).
In addition, they found that the mean fluoroscopy time was significantly lower after the first 50 robotic procedures had been performed (61.8 + 23.2 minutes vs. 44.5 + 23.6 minutes, respectively; P < 0.0001).
In a second, much smaller study published last November, his team examined 70 patients who underwent ablations with the Hansen Robotic System. Unfortunately, this study saw a 32% complication rate for these patients, including 6 who had procedure-related vascular complications. “It’s important to think about potential problems and to put procedures in place to deal with anything that may come up,” said Dr. Natale. “There is a learning curve, no doubt about that. However, we did have a 76% success rate, which was good.”
A recent analysis study showed that only 2 of 40 European patients (5%) and 2 of 268 Austin, TX patients (1.1%) who underwent afib ablation with remote robotic navigation experienced any complications at all. Plus, an ongoing analysis of the acute complication rate with this system in over 1,300 consecutive patients worldwide undergoing atrial catheter ablation showed an overall complication rate of just 1.1%.
“The overall efficacy of robotic navigation seems good and we’re working on getting complication rates down,” said Dr. Natale. These include being careful when gaining access by using long introducers and an over-the-wire approach to avoid vascular complications, reducing the power since the robotic systems now provide better contact, and monitoring esophageal temperature. “Without monitoring, there may be damage. But monitoring can get rid of this complication.”
He concluded, “Robotic technology is here to stay and it’s changing the paradigm of how we do things.”
From Boston Atrial Fibrillation Symposium Session on Current Status of Remote and Robotic Navigation for AF Ablation
Deborah Brauser is a freelance medical reporter and a member of the Association of Health Care Journalists