THE FIRST EXPERIENCE OF ROBOT-ASSISTED CATHETER ABLATION IN ATRIAL FIBRILLATION

To assess efficacy and safety of robot-assisted catheter pulmonary vein isolation during interventional treatment of atrial fibrillation, 55 patients with paroxysmal, persistent, and long-term persistent atrial fibrillation were assessed and surgically treated. To assess efficacy and safety of robot-assisted catheter pulmonary vein (PV) isolation during interventional treatment of atrial fibrillation (AF), 55 patients aged 35 72 years (median: 59 years) were surgically treated. The disease history was 6 216 months (median: 48 months; IQR: 24 72 months). The study group included 22 women (40%) and 33 men (60%) with paroxysmal AF (n=43; 78.2%), persistent AF (n=10; 18.2%), or long-term persistent AF (n=2; 3.6%). In 5 patients (9.1%) with paroxysmal AF, the concomitant typical isthmus-dependent atrial flutter was revealed. Prior to the procedure, trans-thoracic echocardiography and multi-spiral computed tomography was performed in all subjects. The procedures were performed under endotracheal anesthesia. The central veins were punctured and catheterized; transseptal catheterization of the left atrium (LA) was performed according to the Ross procedure with subsequent systemic administration of heparin. The anatomic reconstruction of LA and PV was performed using the Carto 3 system. The Artisan telescopic introducer with the Thermocool SF NAV DF irrigated ablative electrode-catheter was placed into LA through the 14F hemostatic introducer. During the antral RFA, the control of catheter pressure on the cardiac wall was performed using the IntelliSense technology. Upon termination of the applications by the circular multipole diagnostic Lasso catheter, the bidirectional conduction block in the area of PV was verified. According to the data of multi-spiral computed tomography of LA and PV, the following anatomic structures were revealed: the common PV collector in 23 patients (41.8%), accessory PV in 7 patients (12.7%), their combination in 7 patients (12.7%), and the standard location of PV in 18 patients (32.8%). The procedure efficacy within the first 6 months assessed in 49 patients was 71.4%. The procedure duration was 90 300 min (median: 180 min). The medical fluoroscopy time was 32 min. The following complications were revealed (n=4; 7.26%): intra-pericardial bleeding (n=3; 5.45%) which required intra-procedural pericardiocentesis and stroke (n=1; 1.81%). The results obtained by the authors were similar to the outcomes of previously conducted studies. The total complication rate revealed by the authors is slightly higher than that documented in an international register: 7.26% and 4.7%, respectively; however, it is similar to that obtained in centers which performed <100 procedures. All complication occurred when the technique was being adopted (the first 25 procedures). Thus, the first experience of application of the robot-assisted navigation system Sensei X was in line with the data of international studies which showed that the technique was effective and safe. The control of pressure on the endocardium, as well as flexibility and stability of the catheter permit one to perform the procedure effectively and rather safely. In case of the complex anatomic structure of LA and PV, application of the technique mentioned above can improve the efficacy and safety of the procedure.

atrial fibrillation, pulmonary veins, left atrium, radiofrequency catheter ablation, robot-assisted intervention, electroanatomic mapping

1. Wilke T., Groth A., Mueller S., et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8,3 million patients. Europace. 2013; 15 (4): 486-93.

2. Camm, A., Lip G., De Caterina R., et al. ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal, 33, 2719-2747.

3. Calkins H., Kuck K., Cappato R., et al. 2012 HRS / EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm, 9, 632-696.

4. Kuck K., Hindricks G., Padeletti L., et al.The Current Status of Cardiac Electrophysiologyin ESC Member Countries. The EHRA White Book 2015.

5. Линчак Р.М., Свешников А.В., Кушенко И.П., и др. Ранние и отдаленные результаты радиочастотной аблации и прогнозирование ее эффективности у больных с фибрилляцией предсердий. Вестник аритмологии. 2012; № 69.

6. Cappato R., Calkins H., Chen S., et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. Feb 1 2010; 3(1): 32-38.

7. Bai R., DI Biase L., Valderrabano M., et al. Worldwide experience with the robotic navigation system in catheter ablation of atrial fibrillation: methodology, efficacy and safety. J Cardiovasc Electrophysiol. 2012 Aug; 23(8): 820-6.

8. Reddy V., Neuzil P., Malchano Z., et al. View-synchronized robotic image-guided therapy for atrial fibrillation ablation: experimental validation and clinical feasibility. Circulation. 2007 May 29; 115(21): 2705-14.

9. Seldinger S. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953 May; 39(5): 368-76.

10. Ross J., Braunwald E., Morrow A. Transseptal left atrial puncture: a new method for the measurement of left atrial pressure in man. Am J Cardiol 1959; 3: 653-5.

11. Calkins H., Kuck K., Cappato R., et al. 2012 HRS / EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol. 2012 Mar; 33(2): 171-257.

12. Di Biase L, Wang Y, Horton R., et al. Ablation of atrial fibrillation utilizing robotic catheter navigation in comparison to manual navigation and ablation: Single-center experience. J Cardiovasc Electrophysiol 2009; 20: 1328-1335.

13. Russo A., Fassini G., Conti S., et al. Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study. J Interv Card Electrophysiol. 2016 Aug; 46(2): 97-103.

14. Ullah W., McLean A., Hunter R., et al. Randomized trial comparing robotic to manual ablation for atrial fibrillation. Heart Rhythm. 2014 Nov; 11(11): 1862-9.