robotic stereotaxis ablation vs manual ?

I am asking the following question for a friend of mine who is going to have a second ablation following a failed one in July. The EP wants to do a manual ablation because he thinks the robotic sterotaxis system is not as effective yet. That system is in place at the hospital so it is not because it is unavailable. My friend is asking for my opinion and I do not have the information to be able to answer him. Can anyone help ? I would very much appreciate it.

My thought is - choose what you think is the best EP to do the ablation & then let him/her choose what he/she thinks are the best tools to do the job.

If you have doubts, choose a different EP. In your friends shoes, I'd make the drive down the state to Weston & see Dr. Pinski at the Cleveland Clinic there.

George is right on. Robots don't come with brains and instant training. I would place higher importance on the experience of the EP and also the yearly volume of complex procedures that he and the center does. If an EP is not expert and trained on the system, than the only advantage that Stereotaxis has is that it is much less likely to cause major adverse events compared to manual, not that this isn't an important consideration. The training curve on the robot magnets is anywhere from 10-25 procedures depending on the manual expertise of the EP according to early publications.

helen,

In theory, robotic catheter ablation has a number of advantages:automatically retaining continuous contact with the surface of the beating heart through the use of a flexible catheter, the ability of maneuver in tight places, reduced fluoroscopy time and a short learning curve. The current reality, however, may be more mixed as indicated by these two contrasting reports:

[content.onlinejacc.org]

<[www.stopafib.org]. Andrea Natale/robotic catheter ablation technology>

So robotics is certainly a work in progress, with reassuring improvements in catheter design (irrigated catheters that keep the temperature down and contact sensing systems that should improve safety and efficacy).

So, I would agree that the bottom line must be EP experience with whatever approach or combination of approaches he uses and how this translates into his or her success- and complication rates for your type of AF.

-- Dick

The two articles linked by Dick specifically deal with the Hansen robot sheath system that is different than the robot magnet system. A more inclusive review of all new technologies co-authored by Burkhardt and Natale was published recently in Circulation.

[circ.ahajournals.org]

I forgot to mention that even if a hospital has a Stereotaxis system, it may not necessarily mean that it is being used in EP procedures or that the center has the needed expertise to use it for EP. Some hospitals, I believe a minority, only use the systems for non-EP procedures.

[www.ncbi.nlm.nih.gov]

Most will not have access to the Circulation article. I think the article below covers most of the same territory.

[jic.epubxpress.com]

Thanks, researcher, for the much more informative article. It is a nice review of the history of CA. The table on p 4 is particularly helpful in understanding the basics of the two robotic systems. This form of the article was easier for me to read:

[jic.epubxpress.com]


-- Dick

Jais made some interesting comments regarding manual and robotic ablation in the video I posted today. He wants further improvements in terms of automation. I am thinking wow, he just wants to sit back and click a few buttons and drink cappuccino. Currently, the magnetic system does have an automated mapping feature and I believe the company has promised a linear lesion ablation option. The robotic sheath system cannot be automated because it has rudimentary feedback on force according to Packer at Mayo.