52. Role of Remote Navigation in Mapping and Ablation of Complex Arrhythmias

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. Sabine Ernst

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch52

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Ernst, S. (2013) Role of Remote Navigation in Mapping and Ablation of Complex Arrhythmias, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch52

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College, London, UK

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • atrial fibrillation;
  • ventricular tachycardia;
  • congenital heart disease;
  • catheter ablation;
  • left ventricular tachycardia;
  • irrigated-tip catheter;
  • magnetic navigation systems;
  • Hansen Medical system

Summary

Recent technological additions to modern electrophysiology laboratories are remote navigation systems that make it possible to perform any ablation procedures in a fully “hands-off” fashion. Two basic principles have been introduced. One approach is based on an outer magnetic field, emitted either by permanent magnets (Stereotaxis) or electromagnets (Magnetecs), while the other is a mechanical system using either steerable sheaths (Hansen) or the steerability of the ablation catheter itself (Amigo). This chapter reviews the concepts of each system and the clinical experience published so far. When available, detailed description of results for specific arrhythmias such as atrial fibrillation, ventricular tachycardia and arrhythmias in patients with congenital heart disease are reviewed. One of the most obvious benefits is the reduction of radiation exposure for the operator. Reduction of radiation exposure for patients is also achieved by most systems, but is more dependent on operator experience and three-dimensional image/mapping implementation. The chapter also discusses the advantages and disadvantages of the various systems and emphasizes specific caveats including major complications (e.g. perforation and esophageal lesions). The technical requirements for the installation of these systems are reviewed, allowing for an informed comparison when contemplating acquisition of a remote navigation system.