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Published in: Clinical Research in Cardiology 12/2013

01-12-2013 | Original Paper

Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome

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

Published in: Clinical Research in Cardiology | Issue 12/2013

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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.
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Metadata
Title
Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome
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
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 12/2013
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-013-0602-1

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