https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; 2Asklepios Klinik Altona Kardiologie und Internistische Intensivmedizin Hamburg, Deutschland; 3Cardiance Clinic Pfäffikon SZ, Schweiz
Background
The three-dimensional (3D) electroanatomical mapping (EAM) systems used for complex electrophysiological procedures are usually operated on site, by field technical engineers (FTE). Due to a lack of skilled personnel, the FTEs usually have to travel between different hospitals and the procedures require thorough planning. Remote access (RA) technologies aim to increase the flexibility in the electrophysiological (EP) lab and maximise healthcare resources use.
Methods
EAM systems were controlled remotely using an integrated audio-visual solution for RA. The FTE worked exclusively in home office and the communication with the operator was established exclusively using the RA system. Consecutive procedures were prospectively recorded and analysed in terms of demographic data, indication, procedural characteristics and periprocedural complications.
Results
A total of 214 catheter ablation procedures using RA were performed in a high volume, tertiary electrophysiological centre in Germany between September 2022 and February 2024. The median age of the population was 67.0 (57.0, 75.0) years and women represented 38.8%, while the median body mass index (BMI) was 25.8 (23.2, 29.4) kg/m2.
A total of 133 (62.1%) underwent an atrial fibrillation (AF) or atrial tachycardia (AT) ablation procedure, including 52 with additional cavotricuspid isthmus (CTI) ablation and one with additional supraventricular tachycardia (SVT) ablation. Another 10 (4.7%) underwent CTI ablation alone. In 2 (0.9%) patients an ablation of the atrio-ventricular node was performed, in 7 (3.3%) a diagnostic electrophysiological study, in 19 (8.9%) an SVT ablation (one with associated CTI ablation) and 43 (20.1%) a ventricular tachycardia (VT) or premature ventricular contractions (PVC) ablation (Table 1).
The median procedure length was 140.0 (102.0, 170.8) minutes. The median number of radiofrequency applications and radiofrequency time were 66 (25, 110) applications and 13.3 (6.5, 22.1) minutes respectively. The fluoroscopy time was 9.4 (6.3, 13.2) minutes, with a median radiation dose of 415.0 (208.5, 665.0) cGy xcm2. The median volume of contract media used was 30.0 (5.0, 50.0) ml. The median amount of heparin administered was 12 000 (7000, 15 000) UI. The use of protamine was reported in 23 (10.7%) cases, with a median amount of 7000 (5000, 7000) UI. Excepting the diagnostic electrophysiological studies (n=7) where no arrhythmia induction was possible, all procedures were successful. No periprocedural adverse event directly related to the use of RA was noted (Table 2). In one case the communication was established via a conventional smartphone because of the instability of the internet-based headphone connection. No change to on-site support was needed.
Conclusion
This is the largest study to date to report on the routine implementation of RA for complex catheter ablation procedures. This approach proved to be safe and feasible and has the potential to increase the feasibility in case of emergency procedures, reduce travel times for FTE and streamline healthcare resources allocation.