David Brill
Cardiac arrhythmia patients can be treated faster, more safely and with less radiation exposure, following the unveiling of a cutting-edge robotic system at the National Heart Centre Singapore (NHCS).
The technology allows electrophysiological catheter ablation to be done by remote control, using magnets to guide the catheter to its target with dexterity that cannot be achieved by hand.
Cardiologists direct proceedings from a computer workstation – sparing them from neck and back pain that can result from manual ablation procedures, which last up to 6 hours. Procedural time is expected to drop to 2-3 hours with the magnetic navigation system.
Twelve patients have already been treated with the system, which is the first of its kind in Southeast Asia.
“The robotic magnetic navigation system can allow us to safely map the heart to 1 to 2 mm accuracy and precision without the use of fluoroscopy,” said Dr. Teo Wee Siong, director of electrophysiology and pacing and senior consultant cardiologist at NHCS.
“This precision cannot be achieved by conventional ablation with our hands manually, no matter how skilled we are. This will definitely improve patient outcome and safety, especially in complex arrhythmia cases such as atrial fibrillation and ventricular tachycardia,” he said.
The procedure eliminates physician radiation exposure and lowers patient exposure by 40 percent compared with conventional ablation. The new catheters are also softer and more flexible than manually operated versions, thereby reducing the risk of damaging the heart walls from 2-3 percent to less than 1 percent.
The feasibility of magnetic navigation systems for catheter ablation was first demonstrated 7 years ago in dogs and pigs. [Circulation 2002;106:2980] The intervening years have seen the technology evolve and progress to human usage, with centers in the US, Italy and Germany among the first to report their results. Some procedural times were initially longer than conventional ablation, but have shortened with growing experience.
Most recently, the Texas Cardiac Arrhythmia Institute, US, reported success in 164 of 193 robotic catheter ablations (85 percent), compared to 159 of 197 manual ablations (81 percent). Mean exposure to fluoroscopy was slightly increased for the first 50 procedures performed with the robotic system (61.8 minutes versus 58.4 minutes for conventional ablation), but dropped to 44.5 minutes over subsequent procedures. [J Cardiovasc Electrophysiol 2009 Jul 28; Epub ahead of print]
NHCS sees around 300 patients each year requiring catheter ablation and an implantable cardioverter-defibrillator. It estimates that around 60 percent of cases could be treated with the new magnetic navigation system.
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