Robotic catheter ablation of left ventricular tachycardia: initial experience

Background

Catheter ablation of ventricular tachycardia (VT) can be technically challenging due to difficulty with catheter positioning in the left ventricle (LV) and achieving stable contact. The Hansen Sensei Robotic system (HRS) has been used in atrial fibrillation but its utility in VT is unclear.

Objective

The purpose of this study was to test the technical feasibility of robotic catheter ablation of LV ventricular tachycardia (VT) using the HRS.

Methods

Twenty-three patients underwent LV VT mapping and ablation with the HRS via a transseptal, transmitral valve approach. Nineteen patients underwent substrate mapping and ablation (18 had ischemic cardiomyopathy, 1 had an apical variant of hypertrophic cardiomyopathy). Four patients had focal VT requiring LV VT mapping and ablation. Procedural endpoints included substrate modification by endocardial scar border ablation and elimination of late potentials, or elimination of inducible focal VT.

Results

Mapping and ablation were entirely robotic without requiring manual catheter manipulation in all patients and reaching all LV regions with stable contact. Fluoroscopy time of the LV procedure was 22.2 ± 11.2 minutes. Radiofrequency time was 33 ± 21 minutes. Total procedural times were 231 ± 76 minutes. Complications included a left groin hematoma (opposite to the HRS sheath), 1 pericardial effusion without tamponade that was drained successfully, and transient right ventricular failure in a patient with previous left ventricular assist device. At 13.4 ± 6.7 months of follow-up (range 1–19 months), recurrence of VT occurred in 3 of 23 patients.

Conclusion

Our initial experience suggests that the HRS allows successful mapping and ablation of LV VT.

Keywords: Catheter ablation, Hypertrophic cardiomyopathy, Left ventricular assist device, Robotic navigation, Ventricular tachycardia

Abbreviations: 3D, three-dimensional, HRS, Hansen Sensei robotic system, ICD, implantable cardioverter-defibrillator, ICE, intracardiac echocardiography, LV, left ventricle, LVAD, left ventricular assist device, LVOT, left ventricular outflow tract, PVC, premature ventricular contraction, RVOT, right ventricular outflow tract, VT, ventricular tachycardia