Technology & Innovations
In manual ablation the doctor controls the catheter tip by a combination of plunger movements, rotation, and advancing and retracting from about three feet away from the heart.
In the Hanson Robotic system, the doctor uses a motion controller with a flexible guide catheter directly responsive to an operator’s touch that replicates an operator’s natural hand movements. The Hanson system is portable and attaches to a procedure table.
The Stereotaxis mouse and click system uses two large magnets that are incorporated into the EP laboratory. It requires a dedicated EP lab and space commitment. After making an ablation, there is about a 5-7 second delay before the operator can move on to another spot.
The doctor interface screen displays fluoroscopy, intracardiac electrograms, and the EAM system. The magnetic vector can be manipulated from the mapping system or fluoroscopy screen.
The Stereotaxis system has reported an excellent safety record. The lower contact forces may reduce pressure-related complications, such as steam pops and perforations. The Hanson system also is equipped with a limited force-sensing technology.
“Automated schemes work reasonably well in the smooth surface of the left atrium but are less reliable in more trabeculated surfaces.” Anecdotally the author has heard that doctors with access to the Stereotaxis system often work manually instead, because it is faster and less exasperating than the 5-7 second delay.
The Hanson robotic system still requires extensive manual skill, while the Stereotaxis system is automated. Even with skilled, experienced operators it is still possible with a robotic system to have misplaced ablation burns or accidents such as perforations. Whereas the magnetic system using a mouse to make the ablations may be safer, and also more capable of being used by new operators.
Should a patient seek out centers with these remote technologies? Probably not. In this author’s opinion, these remote systems will not survive if they cannot incorporate the advances in catheter development described above.
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Last updated: Sunday, February 15, 2015