支持部分由公司Magnetecs（Inglewood，加利福尼亚，美国）在与马德​​里自治区和拉巴斯大学医院合作。我们感谢他们的帮助，插图中的数字和视频编辑伊万菲尔盖拉斯罗摩和海梅·帕洛莫Cousido的。

患者进行消融的左或右心房扑基板（ 表1）。在场的失代偿期或严重的全身性疾病，血栓左心房内，肾功能衰竭，年龄&lt;18岁，体重指数&gt; 40，怀孕排除标准。该协议的一部分，最初的安全性和可行性协议，由该机构研究和伦理委员会批准。无房颤的程序，包括在此协议。所有患者给予知情同意。 1。机器人磁导航系统说明导管制导控制和成像系统（CGCI）采用8个强大的电磁铁产生高度灵活的优化集中，并包含磁场内磁腔几乎完全在有效控制区域的磁场（0.16特斯拉）。磁腔默默工作，有没有移动部件，冷却电磁铁线圈与无毒的矿物油。磁腔线圈电流调节放大器提供电源。该系统产生的磁场强度的10〜20倍比磁共振成像和无磁场时产生的，所以不能在磁性引导模式。磁场发生器提供用于移动，定位和引导的导管的前端配有三个连接到其前端的永久磁铁颗粒的扭矩和力。 机器人系统包括一个操作台，CGCI控制器计算机和电动线性导管推进机制。该系统使用一个标准的3轴操纵杆，这是用来旋转磁场和手动推进或缩回导管。 3D控制器是用来推导管在任何屏幕化的方向发展。 C臂X射线可旋转或摘录在操作控制台使用的X射线对话框。操作系统的控制台上的统一的显示的CGCI系统，电解剖标测系统，EP记录系统，心腔内超声（ICE），和X-射线。它允许直接在电解剖标测系统和EP录音系统的键盘和鼠标控制。通常情况下，用于屏幕中心的电解剖标测系统画面，CGCI图形叠加。 2。病人的准备承认病人到医院的当天或前一天的程序。隔夜空腹状态下是必需的。 <ol><li>在手术台上的病人，护理人员cannulates外周静脉导管手术前的位置。 </li><li>外磁室，医务人员获得左，右股静脉用利多卡因局部麻醉下访问。将护套导引器，分为左，右股静脉。我们建议指导左心房使用intracard基板的IAC介绍，通过探头9法语（FR）超声心动图，左股静脉鞘，并定位到右心房。 </li><li>对于左心房基板，辖首次静脉注射和重复剂量肝素保持250-300第活化凝血时间。 </li><li>辖2毫克咪达唑仑，然后持续静脉丙泊酚镇静和在操作过程中间歇性静脉注射盐酸吗啡了初始剂量。 </li></ol> 3。传统的电生理研究<ol><li>位置标准导管通过股鞘引荐入右心腔的常规诊断的电生理研究。使用透视检查指导，在手动定位。 </li><li>放置10极导管进入冠状动脉窦和一个螺丝在导管右心房隔。 </li><li>介绍一个特殊的可操纵鞘沿其末端的3个电极通过右股静脉（ 图1A），并将其放置于下腔静脉或右心房较低。 </li><li>一个7神父磁化的导管引入到心脏腔室通过特殊的鞘（ 图1A，图1B）。接下来，执行常规工作心律失常的机制。 </li><li>如果需要（例如，左心房扑动的机制），反式间隔进入左心房是通过使用反式间隔鞘和连续ICE监测。左心房扑动程序也放置一个多极化的导管进入左心房，通过跨室间隔穿刺。 </li></ol> 4。准备为远程导航。导管，护套和导管推进机制大会<ol><li>的电动线性的导管推进机构由进行灭菌轮驱动齿轮箱的电动机底座。它还包括一个一次性鞘剪辑和腿部的安装（ 图2A）。该设备添加或删除Ş导管松弛。 </li><li>安装在剪辑鞘，将导管插入鞘，手动前进到左/右心房。后者是由映射系统和X线透视确认。对于左心房基板位置鞘在右心房房间隔接近。 </li><li>接下来，放置导管的辊轴之间的四轮驱动变速箱通过拇指杆拉回。 </li><li>内磁室，X光C臂移动到其工作位置。现在前进到患者的表在磁场内定位胸廓。 </li><li>操作员离开手术室，从操作控制台进行控制。 </li><li>现在的中心屏幕上显示的磁导​​管和特殊电极护套。 CGCI所有电解剖标测系统运作功能是可供的CGCI操作控制台。 </li></ol> 5。远程Navigation和映射<ol><li>执行的电气耦合指标体系的导管接触校准。最大和最小的接触值被设置在控制面板上。 </li><li>与电解剖标测系统和闭环伺服系统的完全集成，允许远程导航和3D几何重建的右/左心腔，它允许以最小的X射线曝光的过程继续。 </li><li>使用右手的三维控制器引导导管的特定网站内的右/左心房，通过改变磁场的方向（ 图2B）。黄色的磁性箭头指示的方向的磁场。使用左手的3轴操纵杆量来控制导管松弛（ 图2C）。在病人的腿下的机动装置，允许添加和缩回导管松弛（ 图2A）。 </li><li>快速变化的磁场强度，可怕产率CTION，梯度推/拉和/或扭矩（弯曲）运动中的导管的远端部分。实时远程导航评估基于电场矢量调整和随后的反应中的导管的尖端。磁图标显示颜色线圈功率值。绿色表示强烈的正面磁场，红色表示一个强烈的负场（ 图3）。 </li><li>导管尖端并列的磁通密度的向量方向。磁场梯度产生的力控制的导管是到0.7T/meter，一个最大的垂直施加的力为25g。 </li><li>执行从4极的磁化导管的几何点收购，一边慢慢移动导管心房室周围。可以得到三维EAM重建的几分钟后（ 图3A，3B）。 </li><li>转向护套定位在右心房的远程导航服务器允许Reaching右下肺静脉可以直接偏转导管穿过房间隔时或之后的一个循环中的相对的壁，然后指向朝向右下肺静脉的导管。 </li><li>生成激活，电压和第一间隔起搏后的地图来表征的折返电路（ 图4A，4B）。确定消融的目标和定位他们对3D几何。 </li></ol> 6。消融。手动和自动导管定位于目标网站<ol><li>在自动磁感应模式，运营商可以自动引导导管电解剖标测系统标签上双击的具体目标。这代表一个重要的功能来创建远程和自动消融线。 </li><li>在自动模式下，对于每个独立的目标和CGCI系统运行，驱动导管的目标点（ 图4C中）。在自动模式下，系统会显示一个目标对话框。这表明预期的目标，范围，时间和目标搜索状态。 </li><li>精度自动定位在目标上的导管也被测量的初始手动定位的导管中的最终位置的距离。以毫米测量距离，并认为是显著的，如果大于3毫米。导管导航精度要求使用电解剖标测系统领域的缩放工具。 </li><li>手动干预自动搜索可以通过使用操纵杆或3D控制器。 </li><li>要终止心律失常射频能量特定的网站标记为目标点，无论是手动或自动引导。心律失常终止折返（ 图4C，4D）中断后恢复窦性心律。快速心房起搏诱导无需重新确认消除心律失常。 </li></ol>

<ol>
	<li>Evans, G. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Percutaneous+Cardiac+Mapping+and+Ablation+Registry:+final+summary+of+results.">The Percutaneous Cardiac Mapping and Ablation Registry: final summary of results.</a> Pacing Clin. Electrophysiol. 11, 1621-1626 (1988).</li><li>Cappato, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Updated+worldwide+survey+on+the+methods,+efficacy,+and+safety+of+catheter+ablation+for+human+atrial+fibrillation.">Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.</a> Circ. Arrhythm. Electrophysiol. 3, 32-38 (2010).</li><li>Lafuente-Lafuente, C., Mouly, S., Longas-Tejero, M. A., Mahe, I., Bergmann, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antiarrhythmic+drugs+for+maintaining+sinus+rhythm+after+cardioversion+of+atrial+fibrillation:+a+systematic+review+of+randomized+controlled+trials.">Antiarrhythmic drugs for maintaining sinus rhythm after cardioversion of atrial fibrillation: a systematic review of randomized controlled trials.</a> Arch. Intern. Med. 166, 719-728 (2006).</li><li>Reddy, V. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catheter+ablation+of+atrial+fibrillation+without+the+use+of+fluoroscopy.">Catheter ablation of atrial fibrillation without the use of fluoroscopy.</a> Heart Rhythm. 7, 1644-1653 (2010).</li><li>Knackstedt, C., Schauerte, P., Kirchhof, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Electro-anatomic+mapping+systems+in+arrhythmias.">Electro-anatomic mapping systems in arrhythmias.</a> Europace. 10, iii28-iii34 (2008).</li><li>Merino, J. L., Guzman, G., Fernandez-Cuadrado, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+fibrillation+ablation+guided+by+computed+tomography.">Atrial fibrillation ablation guided by computed tomography.</a> Rev. Esp. Cardiol. 62, 13133308 (2009).</li><li>Merino, J. L., Refoyo, E., Peinado, R., Cuesta, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+representation+of+multielectrode+ablation+catheters+by+integration+of+computed+tomographic+geometry+with+three-dimensional+electroanatomic+mapping+of+left+atrium+and+pulmonary+veins.">Real-time representation of multielectrode ablation catheters by integration of computed tomographic geometry with three-dimensional electroanatomic mapping of left atrium and pulmonary veins.</a> Heart Rhythm. 5, 628-629 (2008).</li><li>Piorkowski, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computed+tomography+model-based+treatment+of+atrial+fibrillation+and+atrial+macro-re-entrant+tachycardia.">Computed tomography model-based treatment of atrial fibrillation and atrial macro-re-entrant tachycardia.</a> Europace. 10, 939-948 (2008).</li><li>Ernst, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+and+robotic+navigation+for+catheter+ablation:+"joystick+ablation".">Magnetic and robotic navigation for catheter ablation: "joystick ablation".</a> J. Interv. Card. Electrophysiol. 23, 41-44 (2008).</li><li>Nguyen, B. L., Merino, J. L., Gang, E. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remote+Navigation+for+Ablation+Procedures+-+A+New+Step+Forward+in+the+Treatment+of+Cardiac+Arrhythmias.">Remote Navigation for Ablation Procedures - A New Step Forward in the Treatment of Cardiac Arrhythmias.</a> European Cardiology. 6, 50-56 (2010).</li><li>Schmidt, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remote+navigation+systems+in+electrophysiology.">Remote navigation systems in electrophysiology.</a> Europace. 10, iii57-iii61 (2008).</li><li>Al-Ahmad, A., Grossman, J. D., Wang, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+experience+with+a+computerized+robotically+controlled+catheter+system.">Early experience with a computerized robotically controlled catheter system.</a> J. Interv. Card. Electrophysiol. 12 (3), 199-202 (2005).</li><li>Ray, I. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+experience+with+a+novel+remote-guided+magnetic+catheter+navigation+system+for+left+ventricular+scar+mapping+and+ablation+in+a+porcine+model+of+healed+myocardial+infarction.">Initial experience with a novel remote-guided magnetic catheter navigation system for left ventricular scar mapping and ablation in a porcine model of healed myocardial infarction.</a> J. Cardiovasc. Electrophysiol. 18, 520-525 (2007).</li><li>Ernst, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+experience+with+remote+catheter+ablation+using+a+novel+magnetic+navigation+system:+magnetic+remote+catheter+ablation.">Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation.</a> Circulation. 109, 1472-1475 (2004).</li><li>Nguyen, B. L., Farkas, L., Marx, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Heart Rhythm Society's 30th Annual Scientific Sessions. , (2009).</li><li>Nguyen, B. L., Merino, J. L., Gang, E. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remote+Navigation+for+Ablation+Procedures+-+A+New+Step+Forward+in+the+Treatment+of+Cardiac+Arrhythmias.">Remote Navigation for Ablation Procedures - A New Step Forward in the Treatment of Cardiac Arrhythmias.</a> European Cardiology. 6, 50-56 (2010).</li><li>Gang, E. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dynamically+shaped+magnetic+fields:+initial+animal+validation+of+a+new+remote+electrophysiology+catheter+guidance+and+control+system.">Dynamically shaped magnetic fields: initial animal validation of a new remote electrophysiology catheter guidance and control system.</a> Circ. Arrhythm. Electrophysiol. 4, 770-777 (2011).</li><li>Bernabei, M. A., Ugarte, R. C., Martin, D. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Heart Rhythm Society's 30th Annual Scientific Sessions. , (2009).</li><li>Saliba, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+fibrillation+ablation+using+a+robotic+catheter+remote+control+system:+initial+human+experience+and+long-term+follow-up+results.">Atrial fibrillation ablation using a robotic catheter remote control system: initial human experience and long-term follow-up results.</a> J. Am. Coll. Cardiol. 51, 2407-2411 (2008).</li><li>Hlivak, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+navigation+in+catheter+ablation+for+paroxysmal+atrial+fibrillation:+midterm+efficacy+and+predictors+of+postablation+arrhythmia+recurrences.">Robotic navigation in catheter ablation for paroxysmal atrial fibrillation: midterm efficacy and predictors of postablation arrhythmia recurrences.</a> J. Cardiovasc. Electrophysiol. 22, 534-540 (2011).</li></ol>

何塞·L.美利奴博士收到临床研究从Magnetecs公司和波士顿科学的补助。何塞·L.美利奴博士担任圣裘德医疗扬声器。刚博士和约书亚沙哈尔有权益在Magnetecs公司

这是第一次使用CGCI远程导航系统的临床报告。它显示了重要的技术特点，方便导航和消融左，右心房基板。该系统可能潜在地克服前磁基于奈厄布的系统的一些设计上的限制。[10]因此，心内膜接触力和导航的心脏腔室内部可以极大提高0.08特斯拉相比，所增加的强度的磁场强度0.16特斯拉中尼俄柏体系。连续和快速成型和重塑的磁场，而不是移动的外部磁铁磁场的改变，13,14提供瞬时传输变化的磁化导致几乎实时远程导航导管的前端。以自动模式CGCI系统还提供了一个真正的闭环伺服系统，有能力保持在所需的解剖导管尖端目标17通过不断调整的磁场的方向和强度。 老师系统，心脏内的操作，通过机械的机器人手臂的转向护套的基础上，允许实时导管的活动12，但使用的机械力来驱动导管不超过手动操作代表了技术进步。使用Sensei系统的初步报告提出的关注率较高，心包填塞，比传统的手动射频交付，18,19可能已经涉及到远程操纵僵硬导向工匠导管（汉森医疗，山景，CA，USA） 。填塞率都优于传统的手工方式，可能会更关系到不同的温度和功率，更多的经验和引进一种具有特殊功能的系统来间接估算导管接触力的组织（智能感知）射频设置20 CGCI系统不需要实验室与特定的磁隔离，因为磁场对病人的躯干高度集中。此外，电生理室可以使用，也可以作为一个传统的电生理实验室，或作为磁性实验室从其常规位置向所述磁性室通过移动病人的表。后者可以手动或通过遥控完成。严重的并发症，如心包积液和心包填塞的情况下，虽然没有大的并发症已经存在的初步经验，将可以消除病人从磁腔≈15秒。 一般缺点，如缺乏实时接触力监测或病变可视化仍然适用的CGCI系统。结合机器人导航与实时接触力导管直接可视化的心房腔，可能是一个未来可行的方法，以增加长期成功消融病变和减少并发症的风险。迄今为止，CGCI系统使用在猪的实验数据已经证实再现的导航和准确，快速的导管定位于心房腔室在选定的消融目标17，一旦消融靶点本地化，该系统具有导航的能力，导管尖端选定的目标，尽管心脏运动和解剖违规行为。此外，在同一动物的尸检研究显示，大多数射频病变透壁[17]在此第一次报告在人类该系统还示出再现的导航和定位准确，快速的导管内的右侧或左侧心房室在选定的消融目标。迅速的磁场调整的使用可能会增强导管尖端在较少的射频应用中的稳定性和结果，以及更少的主要并发症。虽然结果和后续的初步经验是令人鼓舞的，未来的大型随机临床试验患者复杂的导管消融程序都需要证明这些潜在的好处。

不同类型的心律失常，心律失常的导管消融已成为一种有效的治疗。1,2抗心律失常药物疗效有限，常常需要，由于二次效应或亲心律失常被撤回。3因此，为消融术是唯一的机会在许多患者的彻底治疗。消融手术需要移动血管系统和心脏导管内室，以进一步确定心律失常基板消融前。正确的导管操作需要一个熟练的电生理透视引导下工作。这可能会导致显着的X射线曝光，这是为患者和医务人员的危险。在过去的二十年中，导致电解剖图（EAM）能够创造出不同的导航系统，以减少X射线曝光4更好地了解心律失常的基板。5-8然而，移动和放置导管eters到特定区域的心脏仍然需要手动引导，这使得这些程序高度依赖于操作者的技能。此外，恒定的心脏跳动使得稳定性的一个射频交纳一定的目标的心脏区域存在的主要问题。新的远程导航系统最近已被开发的，目的是克服这些限制，并允许运营商相差的X射线源，而他们正在内的心血管系统的导管。9-11两个远程导航系统目前市售机器人导管控制系统（医疗，汉森老师系统）12和磁的导管导航系统（系统奈厄布，立体定向）。13,14前者是基于两个转向护套任何常规的导管，通过它可以引入以进行进一步操作通过拉线机构由机器人臂固定在一个标准的X线透视表中。的S&#39;第二系统是基于两个永久磁铁定位在病人的身体的每一侧，以产生均匀的磁场。磁铁固定到其前端的特殊导管的心脏腔室之内，可以进行导航，通过改变外部磁场的方向。在Sensei和奈厄布分别存在一些缺点，如安全性和类似的手动导航或组织的接触力较弱，缺乏实时导管响应。 在这份报告中，我们描述了最近开发的导航系统，导管指导，控制和成像（CGCI）的特性和潜在的消融能力。15,16

<table><tbody><tr><td>Radiofocus Introducer II 7 Fr.</td><td>Terumo</td><td>RS*R70N10MQ</td><td></td></tr><tr><td>Radiofocus Introducer II 6 Fr.</td><td>Terumo</td><td>RS*R60N10MQ</td><td></td></tr><tr><td>Avanti+ Introducer 9 Fr.</td><td>Cordis, Johnson Johnson</td><td>504-609X</td><td></td></tr><tr><td>Pecutaneous Transeptal Catheter Introducer Set 8 Fr.</td><td>Medtronic</td><td>008591</td><td></td></tr><tr><td>Brockenbrough Curved Needle</td><td>Medtronic</td><td>003994</td><td></td></tr><tr><td>Percutaneuos Transeptal Catheter Introducer Agilis ES</td><td>St. Jude Medical</td><td>3271521</td><td></td></tr><tr><td>BRK Transeptal Curved Needle</td><td>St. Jude Medical</td><td>407205;</td><td></td></tr><tr><td>Extension Set</td><td>Sendal</td><td>L-303/100</td><td></td></tr><tr><td>Extension Tube (25 cm)</td><td>Iberhospitex S.A</td><td>0044402</td><td></td></tr><tr><td>BD Eclipse Needle 25G x 5/8 (0.5 mm x 16 mm)</td><td>BD</td><td>305760</td><td></td></tr><tr><td>BD Eclipse Needle 21G x 1 1/2 TW (0.8 mm x 40 mm)</td><td>BD</td><td>305895</td><td></td></tr><tr><td>Surgical Gloves Sterile</td><td>Semperit Technische Produkte Gesellschaft m. b. H. Division Sempermed</td><td>826054720</td><td></td></tr><tr><td>Adult Cannula with 2.1 m Tubing</td><td>Wolfram Droh GmbH</td><td>MDRNC-03N</td><td></td></tr><tr><td>Oxygen Mask</td><td>Carburos Medica Grupo Air Products</td><td>75098</td><td></td></tr><tr><td>Saline</td><td>Baxter S.L.</td><td>PE1324</td><td></td></tr><tr><td>Saline </td><td>Laboratorios Grifols</td><td>3033986</td><td></td></tr><tr><td>Sterile Disposable Scalpel</td><td>Sovereign</td><td>D16390</td><td></td></tr><tr><td>I.V. Set for Gravity Infusion</td><td>Sendal</td><td>NT-820-ELL180</td><td></td></tr><tr><td>Sterile Banded Bag</td><td>Barrier</td><td>705845</td><td></td></tr><tr><td>Sterile Gauzes</td><td>Ortopedia y Cirug&amp;#237;a, S.L.</td><td>0323</td><td></td></tr><tr><td>Sterile Syringe</td><td>BD Plastipak</td><td>302188</td><td></td></tr><tr><td>Infusion Set. Anti-Siphon Valve 15 &amp;mu;m Filter</td><td>Alaris</td><td>273-002</td><td></td></tr><tr><td>Infusion Pump (x4)</td><td>CardinalHealth</td><td>25042ESD1</td><td></td></tr><tr><td>Povidone-iodine (antiseptic for topical application) </td><td>Lainco, S.A.</td><td>619791.2 EFP</td><td></td></tr><tr><td>Morfine Hydrochloride 1%</td><td>B. Braun</td><td>451062</td><td></td></tr><tr><td>Propofol </td><td>Fresenius Kani</td><td>600514</td><td></td></tr><tr><td>Heparin</td><td>Hospira Productos Farmac&amp;#233;uticos y Hospitalarios, S.L.</td><td>Q63004</td><td></td></tr><tr><td>Lidocaine 1%</td><td>B. Braun</td><td>645598</td><td></td></tr><tr><td>Midazolam</td><td>B. Braun</td><td>602567</td><td></td></tr><tr><td>Iodixanol Injection 320 mgI/mL</td><td>GE Healthcare</td><td>687251.2</td><td></td></tr><tr><td>Pre-gelled Electrosurgical Plate</td><td>Blayco</td><td>2125-5</td><td></td></tr><tr><td>Single Patient Use ECG Electrodes</td><td>Ambu</td><td>SP-00-S/50</td><td></td></tr><tr><td>Irrigated Magnetic Navigation Catheter MagnoFlush Gold Tip 4 mm.</td><td>MedFact Engineering GmbH</td><td>100-002</td><td></td></tr><tr><td>Screw-in Catheter. Temporary Transcenous Pacing Lead System</td><td>Medtronic</td><td>6416-200</td><td></td></tr><tr><td>Extension Cable</td><td>Medtronic</td><td>9670560</td><td></td></tr><tr><td>Extension Cable (Number of pins 10) (x2)</td><td>Bard Electrophysiology</td><td>560004A</td><td></td></tr><tr><td>Extension Cable (Number of pins 4)</td><td>Bard Electrophysiology</td><td>560002P</td><td></td></tr><tr><td>Extension Cable </td><td>St. Jude Medical</td><td>ESI-42-04644-001</td><td></td></tr><tr><td>Extension Cable </td><td>St. Jude Medical</td><td>SJM 100011418</td><td></td></tr><tr><td>Connection Cable from IBI-Generator to MedFact RF-Ablation Catheter</td><td>MedFact Engineering GmbH</td><td>100-013</td><td></td></tr><tr><td>Decapolar Catheter Bard Viking 6F Josephson 115 cm</td><td>Bard Electrophysiology</td><td>400034</td><td></td></tr><tr><td>Multipolar (24 poles) Woven Diagnostic Electrode Catheter</td><td>Bard Electrophysiology</td><td>6FMC00798</td><td></td></tr><tr><td>Ensite NavX System (Version 8.1)</td><td>St. Jude Medical</td><td>100022310</td><td></td></tr><tr><td>Ensite System Patient Interface Unit</td><td>St. Jude Medical</td><td>75-05049-001</td><td></td></tr><tr><td>Ensite NavX Surface Electrode Kit</td><td>St. Jude Medical</td><td>EN0010-002</td><td></td></tr><tr><td>Irrigation Qiona Pump</td><td>MollerMedical GmbH. Biotronik SE Co.</td><td>363270</td><td></td></tr><tr><td>External Defibrillator/Monitor LifePaK12</td><td>Medtronic</td><td>073-20719-10</td><td></td></tr><tr><td>X-Ray C-Arm Ziehm Vision2 FD Vario</td><td>Ziehm Imaging</td><td>TS04_001a</td><td></td></tr><tr><td>Cardiac Ablation Generator. Software Version V3.0</td><td>Irvine Biomedical, Inc. A St. Jude Medical Company</td><td>IBI-1500T11</td><td></td></tr><tr><td>IBI-1500T11 Remote Control</td><td>Irvine Biomedical, Inc. A St. Jude Medical Company</td><td>85524</td><td></td></tr><tr><td>Dispersive Electrode Filter </td><td>St. Jude Medical</td><td>3183417</td><td></td></tr><tr><td>Stimulus Generator Unit for EPS 320 Cardiac Stimulator Models</td><td>Micropace Pty. Ltd.</td><td>MP3008</td><td></td></tr><tr><td>Lab System Pro EP Recording System</td><td>Bard Electrophysiology</td><td></td><td>The system includes several components provided by the company</td></tr><tr><td>NEC Multisync LCD Screen</td><td>Micropace Pty. Ltd.</td><td>3892D240</td><td></td></tr><tr><td>Whole Blood Microcoagulation System. Hemochron Jr.</td><td>International Technidyne Corporation (ITC)</td><td>HJ7023</td><td></td></tr><tr><td>Cuvettes for ACT for performance on the Hemochron</td><td>International Technidyne Corporation (ITC)</td><td>FB5033</td><td></td></tr><tr><td>Ultrasound Catheter ViewFlex PLUS 9 Fr.</td><td>St. Jude Medical</td><td>VF-PM</td><td></td></tr><tr><td>ViewFlex Catheter Interface Module</td><td>St. Jude Medical</td><td>20-1783-0000</td><td></td></tr><tr><td>HD11 Digital Ultrasound Machine</td><td>Philips</td><td>US30975460</td><td></td></tr><tr><td>CGCI, Magnetic Navigation System, Catheter Guidance, Control and Imaging System</td><td>Magnetecs Corporation</td><td></td><td>The system includes several components provided by the company. Further support and information may be obtained at: &lt;ul&gt; &lt;li&gt; EU Service and Technical Support: support@magnetecs.com &lt;/li&gt; &lt;li&gt;USA Service and Technical Support: support@magnetecs.com USA Tel. 310-649-9000&lt;/li&gt; &lt;/ul&gt; </td></tr></tbody></table>

remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures

已经开发新的远程导航系统，以改善目前的限制，传统的手动引导基材如左心房扑动在复杂的心脏导管消融。本协议描述所有的临床和在人体的电生理研究和消融导管指导，控制和成像系统（CGCI）评估的准确性，安全性和实时导航微创介入步骤进行。患者进行消融的左或右心房扑基板都包括在内。具体来说，从三个左心房扑动和两个逆时针右心房扑动程序的数据在本报告中。一位代表左心房扑动过程显示在电影中。该系统是基于8个线圈芯电磁铁，生成了一个动态的磁场集中在心脏上。 （毫秒）的急剧变化中的磁场的大小和一个非常灵活的磁化导管一个远程导航LLOW闭环实时整合和精确，稳定的定位和消融致心律失常基板。

这种新的远程磁导航系统允许远程实时导航导管内左，右心房室，无论是在操作模式或自动模式。后者得到几乎是瞬时的扭矩的方向和强度的磁场矢量调整后，弯曲，旋转，和场梯度的轴向推 - 拉运动（为了说明，请参阅视频）。 该系统允许终止心律失常射频交货的缺乏主要并发症（心包填塞，肺栓塞或重大出血）后，在此初始消融经验（ 图4）。 自动化导管远程导航是高度重复性，准确，快速定位所需的目标，并保持导管尖端。基于五个最初的实验程序导航95.7％的重复性，平均精度为1.9±0.9毫米的平均时间达到的目标为23.28±14.8秒。我们考虑了九个目标在右心房（冠状静脉窦，2处高右心房，三尖瓣环的位置，他的上腔静脉和下腔静脉），在左心房的九个目标（2个位置在左边心耳，二尖瓣环和3个位置，一个位置，在每个人的肺静脉），在右心室的六个目标网站（2处右心室流出道，心尖部，右心室游离壁，下壁及室间隔）和五个在左心室的多个目标（先端，前壁，侧壁，隔垫和左心室流出道）。无论是时间，达到目标站点的准确性或再现室和目标显着差异。 <table border="1"><tbody><tr><td> 心律失常的类型 </td><td> 心房基质 </td><td> 消融类型 </td><td><stron<html> g&gt;的急性成功</td><td> 程序源性并发症*** </td><td> 复发 </td></tr><tr><td rowspan="3"> LA扑组（n = 3） </td><td>右肺静脉</td><td>后壁线</td><td>是</td><td>无</td><td>第6个月付</td></tr><tr><td> "左"的PV </td><td>车顶线条</td><td>是* </td><td>无</td><td>第4个月付</td></tr><tr><td>劣质侧壁</td><td>焦距射频交付</td><td>有** </td><td>无</td><td>第3个月付</td></tr><tr><td rowspan="2"> RA扑（N = 2） </td><td rowspan="2">逆时针的Cavo tricuspidIsthmus的依赖RA扑</td><td rowspan="2"> CAVO tricuspidIsthmus线</td><td>是</td><td>无</td><td>第10个月付</td></tr><tr><td>是</td><td>无</td><td>第11个月付</td></tr></tbody></table>_content"&gt; 表1。心房基板和消融结果CGCI系统。FU:跟进。LA:左心房。RF:射频。RA:右心房。PV:肺静脉。* 2更多的非持续，非临床感应LA扑形态。** LA扑不再重新诱导。诱导房颤研究结束。***腔内超声评估整个过程中存在心包积液。 <img src="/files/ftp_upload/3658/3658fig1.jpg" alt="图1" /> 图1。敏锐ES护套（A）和MedFact磁化，用于灌溉金尖导管（B）在左，右心房室的几何重建和消融。 <img src="/files/ftp_upload/3658/3658fig2.jpg" alt="图2" /> 图2。远程导航组件。A，电动线性导管推进机制进行灭菌 ​​轮传动齿轮箱和电机基地。它包括一个一次性鞘剪辑和腿部安装。磁化的导管鞘插入到右/左心房和手动先进乙 ，右手三维控制器用于引导导管心房腔室，通过改变磁场的方向，特定网站内:C，左手3轴操纵杆来控制导管松弛量。 <img src="/files/ftp_upload/3658/3658fig3.jpg" alt="图3" /> 图3。三维电解剖标测左心房和肺静脉的几何形状的几何点收购内使用白尖和覆盖黄色箭头表示磁化的导管，左心房。磁图标显示线圈断电的valUES颜色:绿色表示强烈的正面磁场，红色表示一个强烈的负场。蓝色的导管进入冠状动脉窦。在红色的螺丝导管置于右心房隔。多极导管显示为黄色。 乙 ，最终视图的三维解剖重建左心房。 MA;二尖瓣环。 <img src="/files/ftp_upload/3658/3658fig4.jpg" alt="图4"/> 图4。左心房扑动后自动引导射频能量传送到特定的网站在左心房后壁右侧肺静脉周围电路中断，电压地图显示密集的疤痕在左心房后壁（灰色）第一篇文章，B，起搏间隔产生表征折返，这是本地化右侧肺静脉周围（后路视图是地图hown）。白色和红色的表示第一起搏后的时间间隔&lt;30毫秒，C和D，在自动模式中，导管被驱动到目标点和心律失常终止线完成后，在左心房后壁，折返电路中断<a href="http://www.jove.com/files/ftp_upload/3658/3658fig4large.jpg" target="_blank">点击这里查看大图</a> 。

Watch this Scientific Journal Video about Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures at JoVE.com

Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

这份报告提供了一个新的远程导航系统的基础上磁驱动力量，最近已引入一个新的机器人工具，用于人类心脏电生理程序的详细说明。

遥控磁导航导管定位准确，实时和心脏电生理消融程序

New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac ...

remote-magnetic-navigation-for-accurate-real-time-catheter

Research

JoVE Journal

Medicine

27.7K 次观看.  La Paz University Hospital. 这份报告提供了一个新的远程导航系统的基础上磁驱动力量，最近已引入一个新的机器人工具，用于人类心脏电生理程序的详细说明。

视频: Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

Magnetically-Assisted Remote Controlled Microcatheter Tip Deflection under Magnetic Resonance Imaging

X-ray fluoroscopy-guided endovascular procedures have several significant limitations, including difficult catheter navigation and use of ionizing radiation, which can potentially be overcome using a magnetically steerable catheter under MR guidance.
	The main goal of this work is to develop a microcatheter whose tip can be remotely controlled using the magnetic field of the MR scanner. This protocol aims to describe the procedures for applying current to the microcoil-tipped microcatheter to produce consistent and controllable deflections.
	A microcoil was fabricated using laser lathe lithography onto a polyimide-tipped endovascular catheter. In vitro testing was performed in a waterbath and vessel phantom under the guidance of a 1.5-T MR system using steady-state free precession (SSFP) sequencing. Various amounts of current were applied to the coils of the microcatheter to produce measureable tip deflections and navigate in vascular phantoms.
	The development of this device provides a platform for future testing and opportunity to revolutionize the endovascular interventional MRI environment.

Current applied to an endovascular microcatheter with microcoil tip made by laser lathe lithography can achieve controllable deflections under magnetic resonance (MR) guidance, which may improve speed and efficacy of navigation of vasculature during various endovascular procedures.

磁力辅助的远程控制微导管尖端偏转根据磁共振成像

X-ray fluoroscopy-guided  endovascular procedures have several significant limitations, including  difficult catheter navigation and use of ionizing ...

科研

生物工程

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

结合消融房颤左心耳封堵

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

医学

Robotic Ablation of Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.

Pulmonary vein isolation (PVI) with an ablation catheter is a curative treatment for atrial fibrillation (AF). Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new robotic catheter system is presented. The goal of the procedure is electrical block between pulmonary vein and left atrium.

房颤消融机器人

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between ...

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons. With this protocol, we demonstrate that even complex procedures such as ablations of atrial fibrillation, that are typically associated with fluoroscopy times of &#62;30 min in conventional settings, can safely be performed with a reduction of &#62;90% in fluoroscopy exposure by the additional use of NFCV.

Radiation exposure is an underestimated risk in complex ablation procedures. Here, we describe a protocol to significantly decrease fluoroscopy time and dosage for both the patient and the lab staff by using a novel non-fluoroscopic catheter visualization system.

非透视导管跟踪透视减少介入电

A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that ...

Cardiac Magnetic Resonance Imaging at 7 Tesla

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher magnetic field strengths and potentially provides improved signal contrast and spatial resolution. While promising results have been achieved, ultra-high field CMR is challenging due to energy deposition constraints and physical phenomena such as transmission field non-uniformities and magnetic field inhomogeneities. In addition, the magneto-hydrodynamic effect renders the synchronization of the data acquisition with the cardiac motion difficult. The challenges are currently addressed by explorations into novel magnetic resonance technology. If all impediments can be overcome, ultra-high field CMR may generate new opportunities for functional CMR, myocardial tissue characterization, microstructure imaging or metabolic imaging. Recognizing this potential, we show that multi-channel radio frequency (RF) coil technology tailored for CMR at 7 Tesla together with higher order B0 shimming and a backup signal for cardiac triggering facilitates high fidelity functional CMR. With the proposed setup, cardiac chamber quantification can be accomplished in examination times similar to those achieved at lower field strengths. To share this experience and to support the dissemination of this expertise, this work describes our setup and protocol tailored for functional CMR at 7 Tesla.

The sensitivity gain inherent to ultrahigh field magnetic resonance holds promise for high spatial resolution imaging of the heart. Here, we describe a protocol customized for functional cardiovascular magnetic resonance (CMR) at 7 Tesla using an advanced multi-channel radio-frequency coil, magnetic field shimming and a triggering concept.

7号特斯拉的心脏磁共振成像

CMR at an ultra-high field (magnetic field strength B0&#160;&#8805; 7 Tesla) benefits from the signal-to-noise ratio (SNR) advantage inherent at higher ...

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

Ventricular tachycardia (VT) in patients with ischemic cardiomyopathy mainly results from endocardial scars after myocardial infarction; those scars represent zones of slow conduction that allow the occurrence and maintenance of reentrant circuits. Catheter ablation enables substrate modification of those low voltage areas and thus can help to alter the scar tissue in such a way that arrhythmias cannot appear anymore. Hospitalizations of concerned patients decrease, quality of life and outcome rise. Consequently, VT ablation represents a growing field in electrophysiology, especially for patients with endocardial scars in ischemic heart disease after myocardial infarction. However, ablation of ventricular tachycardia remains one of the most challenging procedures in the electrophysiology lab. Precise scar definition and localization of abnormal potentials are critical for ablation success. The following manuscript describes the use of a multipolar mapping catheter and 3-dimensional (3D) mapping system to create a high density electro-anatomical map of the left ventricle including a precise scar representation as well as mapping of fractionated and late potentials in order to allow a highly accurate substrate modification.

With the following protocol, we provide an approach to Ventricular Tachycardia (VT) ablation using high density mapping with a multipolar catheter and 3D mapping system enhancing the success of the procedure.

采用多极导管三维测图系统进行缺血性室性心动过速的高密度电解剖重建

Ventricular tachycardia (VT) in patients with ischemic cardiomyopathy mainly results from endocardial scars after myocardial infarction; those scars ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

电磁导航经胸结节定位用于微创胸外科手术

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

Real-Time Magnetic Resonance Guided Focused Ultrasound for Painful Bone Metastases

Bones are one of the most common sites of cancer metastasis, which usually causes pain and impairs quality of life. Radiation therapy combined with opioids is the standard treatment for painful bone metastases. This treatment achieves effective pain control in 60&#8722;74% of patients, but limited treatment choices with limited benefits are available for recurrent or residual painful bone metastases after radiotherapy. More than 40% of patients still experience moderate to severe bone pain after reirradiation. Magnetic resonance-guided focused ultrasound (MRgFUS) combines high-intensity focused ultrasound, which achieves thermal ablation of bone metastases and subsequent pain reduction, with real-time magnetic resonance (MR) thermometry to monitor the temperature of anatomic MR images, with an accuracy of 1 &#176;C, spatial resolution of 1 mm, and temporal resolution within 3 s. As well as being increasingly used clinically for controlling metastatic bone pain, the use of MRgFUS for other diseases has also been tested. However, the use of MR software as a thermometer is the only technique available to verify the accuracy of the software and assure energy delivery. Here, we describe an efficient method of quality assurance we developed for thermal detection and energy delivery before each MRgFUS treatment and also propose a modified workflow to expedite the treatment course as well as to reduce patients&#39; pain during the procedure.

Magnetic resonance could offer real-time monitoring of the position and temperature of focused ultrasound in thermal ablation for painful bone metastases, regardless of cancer type or previous local treatments. Our innovative method of quality assurance could facilitate the application of this effective and safe treatment.

Bones are one of the most common sites of cancer metastasis, which usually causes pain and impairs quality of life. Radiation therapy combined with ...

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

It is now well recognized that heart failure (HF) patients with left bundle branch block (LBBB) derive substantial clinical benefits from cardiac resynchronization therapy (CRT), and LBBB has become one of the important predictors for CRT response. The conventional tachypacing-induced HF model has several major limitations, including absence of stable LBBB and rapid reversal of left ventricular (LV) dysfunction after cessation of pacing. Hence, it is essential to establish an optimal model of chronic HF with isolated LBBB for studying CRT benefits. In the present study, a canine model of asynchronous HF induced by left bundle branch (LBB) ablation and 4 weeks of rapid right ventricular (RV) pacing is established. The RV and right atrial (RA) pacing electrodes via the jugular vein approach, together with an epicardial LV pacing electrode, were implanted for CRT performance. Presented here are the detailed protocols of radiofrequency (RF) catheter ablation, pacing leads implantation, and rapid pacing strategy. Intracardiac and surface electrograms during operation were also provided for a better understanding of LBB ablation. Two-dimensional speckle tracking imaging and aortic velocity time integral (aVTI) were acquired to validate the chronic stable HF model with LV asynchrony and CRT benefits. By coordinating ventricular activation and contraction, CRT uniformed the LV mechanical work and restored LV pump function, which was followed by reversal of LV dilation. Moreover, the histopathological study revealed a significant restoration of cardiomyocyte diameter and collagen volume fraction (CVF) after CRT performance, indicating a histologic and cellular reverse remodeling elicited by CRT. In this report, we described a feasible and valid method to develop a chronic asynchronous HF model, which was suitable for studying structural and biologic reverse remodeling following CRT.

The establishment of a chronic asynchronous heart failure (HF) model by rapid pacing combined with left bundle branch ablation is presented. Two-dimensional speckle tracking imaging and aortic velocity time integral are applied to validate this stable HF model with left ventricular asynchrony and the benefits of cardiac resynchronization therapy.

心脏再同步治疗在左束分支消融和快速起搏诱发的异步心力衰竭模型中的益处

It is now well recognized that heart failure (HF) patients with left bundle branch block (LBBB) derive substantial clinical benefits from cardiac ...

生物学

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Rapid, safe, and effective cardiac mapping is critical for the management of complex arrhythmias, yet current methods face significant limitations. The 12-lead electrocardiogram (ECG), while essential for initial diagnosis, lacks the spatial resolution and depth needed to guide advanced procedures such as catheter ablation or cardiac resynchronization therapy device implantation. On the other hand, invasive mapping techniques provide detailed electrical activity but require multiple catheter placements, increasing procedural risks and complexity. These methods are time-consuming, expensive, and offer limited real-time assessment, especially in dynamic arrhythmias like atrial fibrillation (AF), unstable arrhythmia, and cardiac resynchronization therapy (CRT).
This study introduces a noninvasive, imageless electrocardiographic imaging (Imageless-ECGI) system designed to complement traditional methods by providing real-time, beat-to-beat cardiac maps. Without the need for pre-procedural imaging, this system captures high-resolution electrical activity across the entire heart, offering a safer and more efficient alternative to invasive mapping. By combining the immediacy of surface recordings with the spatial accuracy of modern computational models, the Imageless-ECGI system bridges the gap between traditional ECG and invasive mapping, potentially transforming the workflow in electrophysiology labs.

This study introduces a novel approach for real-time cardiac mapping using a noninvasive, imageless electrocardiographic imaging system. This system enables the acquisition of electrophysiological cardiac maps without requiring pre-procedural computed tomography or magnetic resonance imaging scans, enabling efficient guidance for cardiac procedures such as ablation and cardiac resynchronization therapy implants.

使用无创无图像心电图成像系统进行实时心脏标测

Rapid, safe, and effective cardiac mapping is critical for the management of complex arrhythmias, yet current methods face significant limitations. The ...