摘要：

We have developed a new approach based on remote navigation and ablation by a magnetic catheter in a large number of patients with paroxysmal, persistent, or permanent atrial fibrillation. The operator sits in a separate control room, away from the X-ray beam and the patient's body. A 4 mm magnetic catheter is integrated with a newly developed electroanatomical mapping system. The catheter is moved by a joystick that allows to and fro movement inside the left atrium. Magnetic field vectors for each navigation target are stored and, if necessary, they are reapplied at any time while the magnetic catheter is navigated automatically. Remote circumferential pulmonary vein ablation is performed with a target temperature of 65°C and a power limit of 50 W. Navigation and ablation targets can be safely and successfully achieved in all patients in a relatively short period of time (usually in less than one hour). The manual approach is totally operator-dependent, while the remote one is not, but it mostly depends on a well-trained team. When combined with an accurate electroanatomical mapping system this remote technology allows not only to optimize contact and stability with tissue, but also to enable movement between preassigned intracardiac points automatically, either avoiding intervening tissue structures or moving at a defined rate across the surface of the intervening tissue. Finally, there is a significant shortening of radiation exposure time, relevant both for the unprotected patient and the operator.

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