Abstract
Reddy et al (Circulation 2007;115:2705, PMID:17502570) examined the feasibility of synchronizing a robotic navigation system with electroanatomic mapping and 3-dimensional computed tomography imaging to perform view-synchronized left atrial (LA) ablation. This study consisted of both porcine experimental validation phase (9 animals) and a clinical feasibility phase (9 atrial fibrillation patients). The mapping catheter was remotely manipulated with the robotic navigation system within the registered computed tomography image of the left atrium (LA) and pulmonary veins. The point-to-surface error between the LA electroanatomic mapping data and the computed tomography image was 2.1 mm and 1.6 mm in the preclinical and clinical studies, respectively. The catheter was remotely navigated into all pulmonary veins, the LA appendage, and circumferentially along the mitral valve annulus. In 7 of 9 animals, circumferential radiofrequency ablation lesions were applied periostially to ablate 11 pulmonary veins. In patients, all of the pulmonary veins were remotely electrically isolated in an extraostial fashion. The authors concluded that this study demonstrates the safety and feasibility of an emerging paradigm for AF ablation involving the confluence of 3 technologies: 3-dimensional imaging, electroanatomic mapping, and remote robotic navigation.
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