Restart Your Heart by Aseem Desai

Author:Aseem Desai
Language: eng
Format: epub
ISBN: 9781626347090
Publisher: Greenleaf Book Group Press
Published: 2020-02-14T16:00:00+00:00

Figure 23

Remote magnetic navigation is a robotic ablation technology that also can be used to treat AFib. Here, two large magnets rotate around a patient and are driven by a combination of computer mouse movements and clicks that direct a magnetic field to “pull” the catheter through the heart, as the catheter has magnets at the tip. Advantages include continuous contact with tissue despite the patient breathing and their heart beating, increased safety, increased accuracy, and reduced X-ray exposure for patient and physician. The safety aspect is due to the catheter being ultra-soft at the tip. This technology has two primary limitations: There is no discrete way to measure the amount of force being applied by the catheter to the tissue surface, and the cost of the technology is prohibitive for many medical centers.

With regard to persistent AFib ablation, additional lesions may be performed. Sometimes this involves creating lines of ablation that act as “fences” to contain the abnormal impulses. These additional lesion sets can include left atrial posterior wall isolation (PWI), left atrial roof line, right atrial cavo-tricuspid isthmus (CTI) flutter line, and complex fractionated atrial electrogram ablation (CFAE). The goal of persistent AFib ablation is to limit the ability of the heart to sustain AFib, the fire. This is in contrast to paroxysmal atrial fibrillation, where the goal is to eliminate triggers, the sparks. For persistent AFib and long-standing persistent AFib, hybrid ablation using an endocardial (inside of heart) approach and epicardial (outside of heart) approach can be very effective. A newer technique called the Convergent Procedure utilizes a minimally invasive approach.

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