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Robotic magnetic navigation

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Robotic Magnetic Navigation (RMN) (also called Remote Magnetic Navigation[1]) uses robotic technology to direct magnetic fields which control the movement of magnetic-tipped endovascular catheters into and through the chambers of the heart for precise mapping of heart chambers, for radiofrequency ablation treatment of cardiac arrhythmias.[2]

Mechanism of Action

Magnetic Catheters

Pull vs. Push

Because the human heart beats during ablation procedures, catheter stability can be affected by navigation technique. Magnetic fields created by RMN technology guide the tip of a catheter using a “pull” mechanism of action (as opposed to “push” with manual catheter navigation), have been associated with greater catheter stability.[3]

Clinical Outcomes

Atrial Fibrilation

"Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is expected to increase as our population ages. The medical management of AF has yielded only modest success, and over the past 15 years, catheter ablation (CA) has become a mainstay in the treatment for AF. Advancements in the tools used for CA have improved outcomes in patients with both paroxysmal and persistent forms of AF."[4]

After long-term follow up, RMN navigation has been associated with better procedural and clinical outcomes for AF ablation when compared with manual catheter navigation for cardiac ablation.[5]

Ventricular Tachyardia

Treatments for ventricular tachycardia include radiofrequency ablation in addition to pharmaceutical therapy and implantable cardioverter-defibrillator (ICD) implantation.[6]

RMN has been shown to be safe and effective for cardiac catheter ablation in various patient populations with ventricular tachycardia.[7][8]

Congenital Heart Disease

Cardiac arrhythmias are commonly associated with congenital heart disease (CHD), especially as individuals born with congenital cardiac defects live longer. Today, approximately 1 million adults are living with congenital heart disease in the United States.[9]

Catheter ablation therapy for arrhythmias in patients with CHD is safe and feasible in children and young adults and is "especially valuable in patients with abnormal cardiac morphologies." RMN has also been associated with "significantly lower radiation exposure compared with the conventional technique" in ablation procedures for CHD-related arrhythmias.[10]

References

  1. ^ Filgueiras-Rama, D; Estrada, A; Shachar, J; Castrejón, S; Doiny, D; Ortega, M; Gang, E; Merino, JL (21 April 2013). "Remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures". Journal of visualized experiments : JoVE (74). doi:10.3791/3658. PMID 23628883.
  2. ^ Da Costa, A; Guichard, JB; Roméyer-Bouchard, C; Gerbay, A; Isaaz, K (2016). "Robotic magnetic navigation for ablation of human arrhythmias". Medical devices (Auckland, N.Z.). 9: 331–339. doi:10.2147/MDER.S96167. PMID 27698569.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  3. ^ Davis, DR; Tang, AS; Gollob, MH; Lemery, R; Green, MS; Birnie, DH (July 2008). "Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures". Pacing and clinical electrophysiology : PACE. 31 (7): 893–8. doi:10.1111/j.1540-8159.2008.01105.x. PMID 18684288.
  4. ^ Gerstenfeld, EP; Duggirala, S (2015). "Atrial fibrillation ablation: indications, emerging techniques, and follow-up". Progress in cardiovascular diseases. 58 (2): 202–12. doi:10.1016/j.pcad.2015.07.008. PMID 26241304.
  5. ^ Yuan, S; Holmqvist, F; Kongstad, O; Jensen, SM; Wang, L; Ljungström, E; Hertervig, E; Borgquist, R (December 2017). "Long-term outcomes of the current remote magnetic catheter navigation technique for ablation of atrial fibrillation". Scandinavian cardiovascular journal : SCJ. 51 (6): 308–315. doi:10.1080/14017431.2017.1384566. PMID 28958165.
  6. ^ "Ventricular Tachycardia | Johns Hopkins Medicine Health Library". www.hopkinsmedicine.org. Retrieved 13 July 2018.
  7. ^ Turagam, MK; Atkins, D; Tung, R; Mansour, M; Ruskin, J; Cheng, J; Di Biase, L; Natale, A; Lakkireddy, D (September 2017). "A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation". Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 49 (3): 227–235. doi:10.1007/s10840-017-0257-3. PMID 28624892.
  8. ^ Akca, F; Önsesveren, I; Jordaens, L; Szili-Torok, T (June 2012). "Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias--a systematic review". Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 34 (1): 65–71. doi:10.1007/s10840-011-9645-2. PMID 22180126.
  9. ^ "For Medical Professionals - Arrhythmias in adult congenital heart disease". Mayo Clinic. Retrieved 13 July 2018.
  10. ^ Roudijk, RW; Gujic, M; Suman-Horduna, I; Marchese, P; Ernst, S (June 2013). "Catheter ablation in children and young adults: is there an additional benefit from remote magnetic navigation?". Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 21 (6): 296–303. doi:10.1007/s12471-013-0408-9. PMID 23595705.
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