Cardiac Case Study: May-June 2008

Cardiac Case Study: May - June 2008

Emory Pioneers New Technology: Performs First Robotic Ablation in the Southeast

By David B. DeLurgio, MD, FACC, Director of Electrophysiology at Emory University Hospital Midtown 

More than 2.5 million Americans have been diagnosed with a complex cardiac arrhythmia, resulting in more than 850,000 hospitalizations each year. This can present a serious challenge to patients and hospitals, and more people will be diagnosed with atrial fibrillation as the population ages. The morbidity associated with atrial fibrillation and its deleterious effect on mortality continue to gain recognition.

At Emory, electrophysiologists use the most advanced technology to detect, diagnose and treat arrhythmias. The Electrophysiology (EP) teams at Emory University Hospital Midtown and Emory University Hospital have been performing successful cardiac ablation procedures on atrial fibrillation patients for years. In this procedure, one or more thin, flexible tubes are guided through blood vessels using X-ray images and directed to the heart muscle. Then, radiofrequency energy is used to destroy small areas of tissue that give rise to abnormal electrical signals.

A New Tool

Emory Healthcare has invested in Hansen Medical’s SenseiTM Robotic Catheter System, a cutting-edge tool designed to treat dysrhythmias of the heart. The system incorporates a robotic sheath that allows the physician to remotely and robotically control the movement of an ablation catheter within a patient’s heart. By electronically translating the physician’s hand movements to the catheter, the Sensei System facilitates accurate positioning, manipulation and control.

Navigating percutaneous catheters to hard-to-reach cardiac sites can be difficult and time-consuming. Now we have a tool that allows our physicians to do robotically what they have always done by hand. We are still trying to manipulate the catheter to the desired location, but hopefully more accurately, more safely and more effectively with the help of the robot-assisted device. Remote placement in the cath lab allows physicians to remain seated throughout the procedure and provides a virtual shield from harmful radiation.

Our first-ever robotic ablation was performed the last week of March on a young-to-middle-aged male with supraventricular tachycardia (SVT; Figure 1A). He had tried various medications, but none were effective in controlling the condition.

Intracardiac tracings of the patient’s rapid heartbeat elicited in the electrophysiology lab prior to robotic ablation

Normal sinus rhythm after a robotic ablation

Preliminary electrophysiologic study revealed evidence of typical atrioventricular (AV) nodal reentry. During SVT, the patient’s heart rate was 186 beats per minute (bpm). Further electrophysiologic study ruled out other types of arrhythmias and confirmed that dual AV nodal physiology was a basis for this patient’s tachycardia.

After consenting to the procedure, the patient was transferred to the electrophysiology lab, where the robot sheath was inserted along with standard catheters. The robotic device was used to map the area of interest in the patient’s heart and direct the ablation catheter to the appropriate site (Figure 2). The procedure was successful in eliminating a lifelong arrhythmia in very short order.

The catheter is controlled robotically by the three-dimensional mouse shown in the center of the picture

Typically, the procedure takes between 1½ and 2 hours, but varies depending on complexity. In this case, the procedure was performed in an outpatient setting, and the patient was discharged the same day. If the patient remains free of arrhythmias over the next month, we anticipate they will not recur.

In terms of invasiveness, robotic ablation is a minor procedure. The catheter is inserted through punctures in the femoral vein and directed to the heart using very precise, stable movements. Because a surgical approach is not required, recovery time is much shorter — patients generally are discharged the same or the next day.

Cardiac catheter ablation is an innovative procedure that continues to be improved. The robotic system represents an important step toward advancing our ability to safely and effectively use ablation to treat atrial fibrillation. However, due to the novelty of the technology, efficacy data are not yet available.

The Emory EP team anticipates using the robot-assisted device primarily for complex ablations because it provides slightly greater stability and ability to manipulate the catheter through intricate anatomy than is possible by hand using current tools. This approach also helps in reducing X-ray exposure, procedure duration and risk to the patient.

If you have a patient that requires complex atrial ablation or if you have any questions about this procedure, please contact Dr. DeLurgio at 404-686-2504.

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