Robotics in invasive cardiac electrophysiology

Abstract

Robotic systems allow for mapping and ablation of different arrhythmia substrates replacing hand maneuvering of intracardiac catheters with machine steering. Currently there are four commercially available robotic systems. Niobe magnetic navigation system (Stereotaxis Inc., St Louis, MO) and Sensei robotic navigation system (Hansen Medical Inc., Mountain View, CA) have an established platform with at least 10 years of clinical studies looking at their efficacy and safety. AMIGO Remote Catheter System (Catheter Robotics, Inc., Mount Olive, NJ) and Catheter Guidance Control and Imaging (Magnetecs, Inglewood, CA) are in the earlier phases of implementations with ongoing feasibility and some limited clinical studies. This review discusses the advantages and limitations related to each existing system and highlights the ideal futuristic robotic system that may include the most promising features of the current ones.

Keywords::

• ablation
• automation
• cardiac electrophysiology
• efficacy and safety
• electromagnetic
• electromechanical
• magnetic
• mapping

Financial & competing interests disclosure

E Gang owns shares in Magnetecs Corp. E Khan is a paid consultant for Catheter Robotics, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Robotics in cardiac electrophysiology has expanded since initially introduced 10 years ago.

• Each robotic system has advantages and limitations related to the underlying manipulation mechanism and related tools.

• Robotics has possibly similar efficacy outcomes in comparison to manual technique, but likely superior safety outcomes.

• Efficacy and safety of each robotic system is variable based on the operating platform.

• Economic evaluation is needed to assess the true value of these systems.

• Robotics with combination of magnetic and mechanical manipulation seems to be the most promising platform.

• More research is needed to assess the true value of these systems.