Non-fluoroscopic catheter visualization using MediGuide™ technology: experience from the first 600 procedures
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A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today's electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution.
After reviewing the currently available publications in the field of MG-supported EP procedures, we describe the workflows for (1) ablation of supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia using MG-enabled diagnostic and ablation catheters, as well as (2) implant of cardiac resynchronization therapy (CRT) devices using sensor-equipped delivery tools including sheaths, sub-selectors, and guidewires.
As shown in several studies [5, 6, 7, 8, 9], MG procedures resulted in similar efficacy as conventional cases but with a significant reduction in fluoroscopy time and dose. In particular, for SVT ablations, the median fluoroscopy time using the MG technology was 0.5 ± 1.4 min compared to 10.2 ± 9.6 min in conventional fluoroscopic settings. Similar reductions were demonstrated for AF ablation procedures from 25 min in conventional settings with electroanatomical mapping systems and live x-ray to 4.6 min with the addition of the MG technology. Recently, it was demonstrated that the application of MG for CRT device implants could successfully result in a median fluoroscopy time of 2.6 min for LV lead deployment.
In summary, the first measurable clinical impact of the MG technology on a daily clinical routine is the reduction of fluoroscopy time and radiation exposure for various EP indications. These beneficial effects were achieved without negative consequences on procedural efficacy, complications, or time in more than 600 EP procedures.
KeywordsCatheter ablation Atrial fibrillation Resynchronization therapy Image integration Mapping Non-fluoroscopic
Cardiac resynchronization therapy
Chronic total occlusion
Electroanatomic mapping system
Implantable cardioverter defibrillator
Pulmonary vein isolation
PS and GH received modest lecture honoraria by St. Jude Medical and are advisory board members by St. Jude Medical. SR received modest lecture honoraria by St. Jude Medical.
MG-enabled catheters are placed in the RVA and CS: on the left panel short fluoroscopy loops (3 s) are continuously repeated and the sensors in the catheter tip are displayed. First, the RVA catheter (green tip) is placed (right panel: EnSite velocity visualization) in RAO. Then a decapolar diagnostic catheter is positioned in the CS (yellow tip) in LAO. An electroanatomical reconstruction of the RA (green shell), the SVC and IVC (blue shell), and the tricuspidal annulus (yellow points) is performed (non-fluoroscopically). (WMV 24224 kb).
- 1.Cappato, R., Calkins, H., Chen, S. A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y. H., Klein, G., Natale, A., Packer, D., Skanes, A., Ambrogi, F., & Biganzoli, E. (2010). Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol, 3, 32–38.PubMedCrossRefGoogle Scholar
- 4.Jeron, A., Fredersdorf, S., Debl, K., Oren, E., Izmirli, A., Peleg, A., Nekovar, A., Herscovici, A., Riegger, G. A., & Luchner, A. (2009). First-in-man (fim) experience with the magnetic medical positioning system (mps) for intracoronary navigation. EuroIntervention, 5, 552–557.PubMedCrossRefGoogle Scholar
- 6.Sommer, P., Wojdyla-Hordynska, A., Rolf, S., Gaspar, T., Eitel, C., Arya, A., Hindricks, G., & Piorkowski, C. (2013). Initial experience in ablation of typical atrial flutter using a novel 3D catheter tracking system. Europace, 15(4), 578–581. doi: 10.1093/europace/eus226. Epub 2012 Aug 2.PubMedCrossRefGoogle Scholar
- 7.Sommer, P., Rolf, S., Gaspar, T., Eitel, C., Derndorfer, M., Martinek, M., Puererfellner, H., Arya, A., Piorkowski, C., & Hindricks, G. (2013). MediGuide in SVT: initial experience from a multicenter registry. Europace, 15(9), 1292–1297. doi: 10.1093/europace/eut090. Epub 2013 Apr 23.PubMedCrossRefGoogle Scholar
- 8.Rolf, S., John, S., Gaspar, T., Dinov, B., Kircher, S., Huo, Y., Bollmann, A., Arya, A., HIndricks, G., Piorkowski, C., & Sommer, P. (2013). Catheter ablation of atrial fibrillation supported by novel non-fluoroscopic 4D navigation technology (MediGuide™). Heart Rhythm, 10(9), 1293–1300. doi: 10.1016/j.hrthm.2013.05.008. Epub 2013 May 14.PubMedCrossRefGoogle Scholar
- 9.Richter S, Döring M, Gaspar T, John S, Rolf S, Sommer P, Hindricks G, Piorkowski C. CRT Implantation Using a New Sensor-Based Navigation System:Results from the First Human Use Study. Circ Arrhythm Electrophysiol. 2013 Sep 3. [Epub ahead of print].Google Scholar
- 14.Estner, H. L., Deisenhofer, I., Luik, A., et al. (2006). Electrical isolation of pulmonary veins in patients with atrial fibrillation: reduction of fluoroscopy exposure and procedure duration by the use of a non-fluoroscopic navigation system (navx). Europace, 8, 583–587.PubMedCrossRefGoogle Scholar
- 18.Dagres, N., Hindricks, G., Kottkamp, H., Sommer, P., Gaspar, T., Bode, K., Arya, A., Husser, D., Rallidis, L. S., Kremastinos, D. T., & Piorkowski, C. (2009). Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern? J Cardiovasc Electrophysiol, 20(9), 1014–1019. Epub 2009 May 20.PubMedCrossRefGoogle Scholar