Johnson, Susa B

Background: Current technologies to fully “register” surrogate maps onto 3D CT (CartoMerge, NavxMerge) or 3D ICE images (CartoSound) have emerged to guide ablation. The feasibility of navigation with the Hansen Robotic Catheter Sheath System (HRCS) has also been reported. Integrated 3D Image and contact force sensor with this robotic system may allow for feasibility and safety for guiding complex anatomic-based ablation. Methods: Circumferential pulmonary vein (PV) ablation with the robotic system guided by integrated 3D images (CartoMerge, NavxMerge or CartoSound) (n=3), were done and compared to manual manipulation guided by the integrated 3D images (CartoSound) (n=8). Each ablation was performed using contact force ranges of 10 –20 grams (20W, 17 ml/min flow, 30 seconds). Accuracy of PV ablation was assessed by comparing distance from the PV ostia (specific 4 sites) to the ablative points on the 3D image structures, and the corresponding distances of the actual ablative lesions at pathologic exam. Results: Using three integrated 3D image systems, circumferential PV ablation was successfully guided in 6 PVs (3 RSPVs and 3 LSPVs) with the robotic system. During all ablations with contact forces of 10 –20 grams, no impedance rises, pops or type 2 microbubbles were seen. Accuracy of the PV ablation was 0.22±0.84 mm (range 0 –2). The PV rings were 100% circumferential by electroanatomic mapping, yielding an 86±7% (range 80 –98%) uninterrupted circumferential ablative ring around each PV with 1.1 ± 0.4 gaps (3.0 ± 0.9 mm). These resulting parameters were equal to those in the integrated 3D image-based manual navigation (Accuracy: 0.5±0.9 (range 0 –2.5) mm, Gaps:1.3 ± 0.9 ( 2.6 ± 0.9 mm), circumferential lesions 88 ± 10% (range 70 –100). Conclusions: This feasibility study demonstrated successful integrated 3D image and contact force-guided robotic ablation. Contact sensor guided 3D volume construction and real time 3D images accurately replicated atrial and venous anatomy, resulting in successful circumferential ablation.