Hospitals use new robotic catheter guidance system to treat abnormal heart rhythms

Hospitals are beginning to use a new robotic catheter guidance system to treat abnormal heart rhythms.

The robotic system "enhances a doctor's natural ability, and we believe it will contribute to improved procedural outcomes," said Dr. David Wilber of Loyola University Health System, a nationally known researcher in heart rhythm disorders.

The robotic system is used in a procedure, called an ablation, which treats irregular heartbeats such as atrial fibrillation. The treatment destroys small areas of heart tissue that trigger irregular heartbeats.

Atrial fibrillation, often called A-fib, is the most common form of irregular heartbeat. More than two million Americans have A-fib, and doctors diagnose about 160,000 new cases each year.

In an ablation, an electrophysiologist inserts a catheter (thin tube) through a small incision in the patient's groin and guides it to the heart. The tip of the catheter delivers radiofrequency energy that burns away small areas in the heart where erratic electrical signals originate.

In a traditional manual procedure, the physician stands over the patient and guides the catheter by gently pushing, pulling, twisting and turning it. By contrast, a physician using a robotic catheter sits at a control station and manipulates the catheter by operating a joy stick. The movement of the catheter is displayed on a computer screen. When, for example, the physician moves the joystick to the right, guidewires embedded in the catheter move the catheter in that direction.

"You get more precise control of the catheter than you can by hand," Wilber said. "You can move the catheter, millimeter by millimeter, exactly where you want it to go."

The robotic system enables the physician to place the catheter in exactly the right spot. And, the correct amount of pressure is consistently applied. The catheter burns away targeted tissue, but does not get so close that it punctures the heart wall.

"The value of the system is that it allows you to give more consistent pressure and more precise control of the catheter than if you do it by hand," Wilber said.

The procedure worked well for patient Suzanne Melton of Arlington Heights, Ill. Melton, an administrative assistant, first experienced A-fib at work, when she felt a burning sensation in her chest. Her cardiologist prescribed sotalol, a drug for irregular heartbeats. But the drug left Melton so fatigued she would take three-hour naps. So her cardiologist referred Melton to Wilber for an ablation.

Since undergoing the procedure, Melton has experienced no more A-fib episodes. "When I feel my pulse, it feels so much stronger than it did before," she said.

The ablation also allowed her to change medications to eliminate fatigue. "I feel great now," she said. "I can stay up all day. I'm back to my normal sleeping patterns. I'm back to my normal life."

A recent study found that when doctors use the robotic system, they spend less time looking at X-ray images of the heart. This reduces X-ray radiation exposure to both patients and doctors. The study, published in the Journal of Cardiovascular Electrophysiology, found that, on average, X-ray time was 48.9 minutes per procedure for the robotic system, compared with 58.4 minutes for a manual system.

Radiation exposure is becoming a more significant problem as high-volume doctors do increasingly complex and lengthy cases. In the robotic system, radiation exposure is dramatically reduced to the operator because the physician is in the control room rather than next to the patient. There also is less physical fatigue because the doctor does not have to stand over the patient for hours while wearing a heavy lead vest to limit radiation exposure.

Erratic electrical activity in the heart causes it to beat either too slowly or too quickly. During A-fib, the upper chambers of the heart quiver instead of beating regularly. Not all the blood gets pumped out, and this can lead to the formation of life-threatening clots.

Symptoms can include palpitations, decreased blood pressure, weakness, fatigue, dizziness, lightheadedness, confusion, shortness of breath and chest pain.

A-fib typically is first treated with drugs. But medications sometimes don't work, or cause significant side effects. In such cases, patients often are referred to electrophysiology centers such as Loyola for ablations. Loyola has one of the highest-volume programs in the Midwest; Loyola physicians perform about 500 ablations per year.