Remote Magnetic Navigation Research Articles

On the Workspace of Electromagnetic Navigation Systems

In remote magnetic navigation, a magnetic navigation system is used to generate magnetic fields to apply mechanical wrenches to steer a magnetic object. This technique can be applied to navigate untethered micro- and nanorobots, as well as tethered magnetic surgical tools for minimally invasive medicine. The design and characterization of these systems have been extensively investigated over the past decade. The determination of the region in space in which these systems can operate has yet to be formalized within the research community. This region is commonly referred to as the “workspace” and constitutes a central concept for any class of robotic system. We focus on magnetic navigation systems comprised of electromagnets and propose a first set of definitions for a magnetic workspace, a methodology to determine it, and evaluation metrics to analyze its characteristics. Our methodology and tools are illustrated with several examples of planar and spatial electromagnetic magnetic navigation systems for both didactic and realistic navigation scenarios.

Challenges of the COVID-19 pandemic in healthcare and the use of robotic technology - The Robotic Magnetic Navigation, to manage them in the field of electrophysiology | A single-center experience with case studies

Challenges of the COVID-19 pandemic in healthcare and the use of robotic technology - The Robotic Magnetic Navigation, to manage them in the field of electrophysiology | A single-center experience with case studies

Magnetically Guided Laser Surgery for the Treatment of Twin‐to‐Twin Transfusion Syndrome

Twin‐to‐twin transfusion syndrome (TTTS) is a severe disorder that often leads to the death of monochorionic twin fetuses, if left untreated. Current prenatal interventions to treat the condition involve the use of rigid fetoscopes for targeted laser coagulation of the vascular anastomoses. These tools are limited in their area of operation, making treatment challenging, especially in cases with anterior placentation. Herein, a robotic platform to perform this task using remote magnetic navigation is proposed. In contrast to rigid tools, the presented custom magnetic fetoscope is highly flexible, dexterous, and has considerable advantages, including safety and precision. A visual servoing algorithm that allows the surgeon to navigate in the uterus with submillimeter precision is introduced. The system has been validated on ex vivo human placentas in a setting that mimics the real intraoperative conditions.

MoSBOTs: Magnetically Driven Biotemplated MoS2 -Based Microrobots for Biomedical Applications.

2D layered molybdenum disulfide (MoS2 ) nanomaterials are a promising platformfor biomedical applications, particularly due to its high biocompatibility characteristics, mechanical and electrical properties, and flexible functionalization. Additionally, the bandgap of MoS2 can be engineered to absorb light over a wide range of wavelengths, which can then be transformed into local heat for applications in photothermal tissue ablation and regeneration. However, limitations such as poor stability of aqueous dispersions and low accumulation in affected tissues impair the full realization of MoS2 for biomedical applications. To overcome such challenges, herein, multifunctional MoS2 -based magnetic helical microrobots (MoSBOTs) using cyanobacterium Spirulina platensis are proposed as biotemplate for therapeutic and biorecognition applications. The cytocompatible microrobots combine remote magnetic navigation with MoS2 photothermal activity under near-infrared irradiation. The resulting photoabsorbent features of the MoSBOTs are exploited for targeted photothermal ablation of cancer cells and on-the-fly biorecognition in minimally invasive oncotherapy applications. The proposed multi-therapeutic MoSBOTs hold considerable potential for a myriad of cancer treatment and diagnostic-related applications, circumventing current challenges of ablative procedures.

Dipole charge density mapping integrated in remote magnetic navigation: First-in-human feasibility study.

AimsRobotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures.Material and methodsIn this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared.ResultsAcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p < 0.01; 181.0 vs. 131.0 mGy, p = 0.02, respectively). Procedure duration and fluoroscopy use decreased significantly between the first 30 and the last 30 AcQMap-RMN procedures. The AcQMap-RMN system had fewer recurrences after persistent AF ablations and was non-inferior in paroxysmal AF patients compared to CARTO-RMN at 12 months (36.6% vs. 75.0%, p = 0.04, PAF 6.6% vs. 12.5%, p = 0.58; respectively). CA of AT outcomes were better using the AcQMap-RMN system (1 year recurrence 17.1% vs. 38.7%, p < 0.05).ConclusionAcQMap-RMN integration has no negative impact on the excellent safety profile of RMN guided ablations. It improves outcomes of CA procedures for persAF and AT but requires longer procedure times and higher fluoroscopy use during the initial learning phase.

A Simulation Framework for Magnetic Continuum Robots

Remote magnetic navigation is a technology used to robotically steer magnetic medical instruments, such as magnetic catheters and guidewires, for minimally invasive surgery. The ability to model and simulate the behavior of these magnetic instruments in complex anatomies is important for their clinical use in many ways. Simulation frameworks can improve their design, characterization, and automatic control capabilities, as well as provide training simulators for physicians. In this work we introduce a new simulation framework that accounts for both magnetic actuation and interactions forces with meshed collision models. The simulations are validated experimentally in planar rigid models using a pre-clinical electromagnetic navigation system. We also demonstrate the use of our framework to build training simulators for two endovascular navigation tasks including the exploration of the aortic arch and the internal carotid artery.

Using Magnetic Fields to Navigate and Simultaneously Localize Catheters in Endoluminal Environments

Remote magnetic navigation offers an ideal platform for automated catheter navigation. Magnetically guided catheters show great dexterity and can reach locations that are otherwise challenging to access. By automating aspects of catheterization procedures, we can simplify and expedite the procedure to allow surgeons to focus on other critical tasks during the surgery. In this article, we describe an automation strategy that is based on the center line of extracted and registered vascular geometries. Position feedback is accomplished with a Hall-effect sensor embedded near the distal end of the catheter. Sensor measurements are compared to the magnetic field predicted by a linear model of the electromagnetic navigation system. By defining specific magnetic field gradients and applying the known vascular geometry, the magnetic fields can be utilized for the simultaneous navigation and localization of the catheter. This eliminates the need for other external, dedicated mapping systems, and the use of fluoroscopy imaging is minimized. The concept is tested in 2d vascular models and the accuracy of the localization is assessed with overhead camera tracking.

The first experience of using robotic magnetic navigation for interventional treatment of post-incisional atrial flutter in patients with congenital heart defects after surgical correction: case series

Post-incisional heart rhythm disturbances are one of the most frequent complications after open cardiac surgery. Lession in the atrial myocardium create conditions for slowing impulse conduction, formation and circulation of reentry. Case series included 8 patients after correction of complex congenital heart disease (CHD) with post-incisional atrial flutter (AF), despite treatment with antiarrhythmic drugs. All patients underwent interventional AF treatment using the robotic magnetic navigation (RMN) system. Perioperative complications, duration of surgery, time of fluoroscopy and efficacy (free of atrial tachyarrhythmias 3 months after the ablation procedure) of treatment were assessed during a follow-up period of 12 months. The article presents a series of clinical cases of RMN application for the treatment of post-incisional AF in patients with CHD after open cardiac surgery. The first Russian experience of using RMN for the treatment of post-incisional AF in patients with CHD after open cardiac surgery demonstrated safety and high efficiency both in the early and long-term follow-up periods. More experience and multicenter studies in a large cohort of patients are needed to determine the role of RMN as the first line of therapy for performing catheter ablation in this category of patients. Received 12 November 2021. Accepted 6 December 2021. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The work is supported by a grant of the President of the Russian Federation No. МД-1997.2020.7 Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: V.V. Beloborodov, A.G. FilippenkoDrafting the article: A.B. Romanov, V.V. Beloborodov, A.G. FilippenkoCritical revision of the article: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, V.V. ShabanovSurgical treatment: A.B. Romanov, V.V. ShabanovFinal approval of the version to be published: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, I.L. Mikheenko, V.V. Shabanov

A novel dipole charge density mapping system integrated in robotics offers advantages for ablation of atrial tachycardias: first-in-human experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) for atrial tachycardia (AT) and atrial flutter (AFL) offers favorable acute and long-term outcomes. Until recently, mapping of AT/AFL was only possible with sequential mapping methods using manually controlled catheters. Even by implementing multielectrode mapping, some limitations exist during mapping of short-lived arrhythmias and ATs with unstable CL. Remote magnetic navigation (RMN) with its atraumatic catheter design has superior safety profile and excellent accuracy. Recently, a novel high-resolution mapping system (AcQMap) can be used in combination with RMN (AcQMap-RMN). Purpose To assess the feasibility, safety and efficacy of AcQMap-RMN guided ablation in the management of complex ATs. Methods All patients undergoing CA for AT/AFL using AcQMap-RMN were included. The AcQMap system utilizes two different types of mapping: Single Position Map (SMP) and SuperMap, allowing mapping of both non-sustained and sustained ATs. Procedural efficiency was characterized by procedure time, total ablation time and radiation doses. Acute success was defined by arrhythmia source elimination. Efficacy data are based on 12-month follow up and number of redo procedures. Procedural safety was evaluated by intra- and post-procedural complications. Results A total number of 76 patients were referred for CA with AT/AFL (mean age 59.0±13.2), including 3 patients with inappropriate sinus tachycardia and 73 patients with AT/AFL. Out of 73 patients, 8 had perinodal AT. From the remaining 65 patients, 38 had de novo, 22 had post-PVI, and 5 patients had post-MAZE AT/AFL. Twenty-nine patients had short-lived ATs and were mapped exclusively by SPM. The mean procedure time was 175.9±61.4 min, mean ablation time 964.0 (IQR 422.0-1693.0) s, and mean radiation dose was 152.0(IQR 86.7-294.0) mGy. Acute success was documented in 70 procedures (92.1%). From de novo AT/AF patients 4 (10.5%), from post-PVI and post-MAZE AT/AFL patients 3 had recurrence at the end of the follow-up period (11.1%). Four patients had redo procedure. Three patients had post-procedural complications including 2 patients with groin hematoma and 1 patient with transient ischemic attack. Conclusion AcQMap-RMN integration offers improved efficiency, high success and low complication rates in complex AT ablation.

PO-666-05 A NOVEL DIPOLE CHARGE DENSITY MAPPING SYSTEM INTEGRATED IN ROBOTICS OFFERS ADVANTAGES FOR ABLATION OF ATRIAL TACHYCARDIAS: FIRST-IN-HUMAN EXPERIENCE

Catheter ablation (CA) for atrial tachycardia (AT) and atrial flutter (AFL) offers favorable acute and long-term outcomes. Until recently, mapping of AT/AFL was only possible with sequential mapping methods using manually controlled catheters. Even by implementing multielectrode mapping, some limitations exist during mapping of short-lived arrhythmias and ATs with unstable CL. Remote magnetic navigation (RMN) with its atraumatic catheter design has superior safety profile and excellent accuracy.

Acute and Long-Term Results of Catheter Ablation of Outflow Tract Arrhythmias using Remote Magnetic Navigation with Catheter–Tissue Contact Feedback Technology: Comparison with Manual Ablation

Acute and Long-Term Results of Catheter Ablation of Outflow Tract Arrhythmias using Remote Magnetic Navigation with Catheter–Tissue Contact Feedback Technology: Comparison with Manual Ablation

Coronary Ostia Mapping with Remote Magnetic Navigation can Facilitate Safe Mapping and Ablation of Outflow Tract Ventricular Arrhythmias

Coronary Ostia Mapping with Remote Magnetic Navigation can Facilitate Safe Mapping and Ablation of Outflow Tract Ventricular Arrhythmias

Radiofrequency Ablation Of Paroxysmal And Persistent Atrial Fibrillation Using Ensite Precision Mapping System And Robotic Magnetic Navigation: The Efficacy, Long-Term Follow-Up Outcome And Recurrence Risk Factors

Radiofrequency Ablation Of Paroxysmal And Persistent Atrial Fibrillation Using Ensite Precision Mapping System And Robotic Magnetic Navigation: The Efficacy, Long-Term Follow-Up Outcome And Recurrence Risk Factors

Remote Magnetic versus Manual Catheter Navigation in the Ablation of Accessory Pathways in Adults

Remote Magnetic versus Manual Catheter Navigation in the Ablation of Accessory Pathways in Adults

A Review on the use of Remote Magnetic Navigation for Ventricular Tachycardia Ablation

A Review on the use of Remote Magnetic Navigation for Ventricular Tachycardia Ablation

Outcomes of Remote Magnetic Navigation in SVT Ablation

Outcomes of Remote Magnetic Navigation in SVT Ablation

A Novel, Highly Efficient And Effective Minimal-Invasive Ablation Strategy for Remote Magnetic Navigation Guided Pulmonary Vein Isolation

A Novel, Highly Efficient And Effective Minimal-Invasive Ablation Strategy for Remote Magnetic Navigation Guided Pulmonary Vein Isolation

Foreword: A Historical Review and Present day Evolution of Robotic Magnetic Navigation

Foreword: A Historical Review and Present day Evolution of Robotic Magnetic Navigation

Systematic review of electrophysiology procedures in patients with obstruction of the inferior vena cava

AimsThe objective of the study was to conduct a systematic review to describe and compare the different approaches for performing cardiac electrophysiology (EP) procedures in patients with interrupted inferior vena cava (IVC) or equivalent entities causing IVC obstruction.MethodsWe conducted a structured search to identify manuscripts reporting EP procedures with interrupted IVC or IVC obstruction of any aetiology published up until August 2020. No restrictions were applied in the search strategy. We also included seven local cases that met inclusion criteria.ResultsThe analysis included 142 patients (mean age 48.9 years; 48% female) undergoing 143 procedures. Obstruction of the IVC was not known before the index procedure in 54% of patients. Congenital interruption of IVC was the most frequent cause (80%); and, associated congenital heart disease (CHD) was observed in 43% of patients in this setting. The superior approach for ablation was the most frequently used strategy (52%), followed by inferior approach via the azygos or hemiazygos vein (24%), transhepatic approach (14%), and retroaortic approach (10%). Electroanatomical mapping (58%), use of long sheaths (41%), intracardiac echocardiography (19%), transesophageal echocardiography (15%) and remote controlled magnetic navigation (13%) were used as adjuncts to aid performance. Ablation was successful in 135 of 140 procedures in which outcomes were reported. Major complications were only reported in patients undergoing AF ablation, including two patients with pericardial effusion, one of whom required surgical repair, and another patient who died after inadvertent entry into an undiagnosed atrioesophageal fistula from a previous procedure.ConclusionThe superior approach is most frequent approach for performing EP procedures in the setting of obstructed IVC. Transhepatic approach is a feasible alternative, and may provide a “familiar approach” for transseptal access when it is required. Adjunctive use of long sheaths, intravascular echocardiography, electro‐anatomical mapping and remote magnetic navigation may be helpful, especially if there is associated complex CHD. With careful planning, EP procedures can usually be successfully performed with a low risk of complications.

The First Evaluation of Remote Magnetic Navigation-Guided Pediatric Ventricular Arrhythmia Ablation

Catheter ablation (CA) is an important treatment option for ventricular arrhythmias (VA) in pediatric cardiology. Currently, various CA techniques are available, including remote magnetic navigation (RMN)-guided radiofrequency (RF) ablation. However, no studies evaluate RMN-guided ablative therapy outcomes in children with VA yet. This study aimed to compare procedural and long-term outcomes between RMN-guided and manual (MAN)-guided VA ablation in children. This single-center, retrospective study included all CA procedures for VA performed in children with or without structural heart disease from 2008 until 2020. Two study groups were defined by CA technique: RMN or MAN. Primary outcome was recurrence of VA. Baseline clinical, procedural and safety data were also evaluated. This study included 22 patients, who underwent 30 procedures, with a median age of 15 (IQR 14–17; range 1–17) years and a mean weight of 57 ± 20 kg. In total, 14 procedures were performed using RMN and 16 using MAN (22 first and 8 redo procedures). Regarding first procedures, recurrence rates were significantly lower in RMN compared to MAN (20% versus 67%, P = 0.029), at a mean follow-up of 5.2 ± 3.0 years. Moreover, fluoroscopy dosages were significantly lower in RMN compared to MAN [20 (IQR 14–54) versus 48 (IQR 38–62) mGy, P = 0.043]. In total, 20 patients (91%) were free of VA following their final ablation procedure. This is the first study to investigate the use of RMN in pediatric VA ablation. RMN showed improved outcomes compared to MAN, resulting in lower VA recurrence and reduced fluoroscopy exposure.