Introduction:

The Hansen robotic system has only recently been used in the United
States for catheter ablation procedures in humans. Atrial fibrillation
(AF) ablation may be performed utilizing this system. We report our
management of complications with early experience of this system.

Methods and Results:

All 71 patients in whom the system was utilized were included. In all
patients, a 2-operator technique was to be employed; one operator
manipulates the ablation catheter via the robot and the other
manipulates the circular mapping and intracardiac echocardiogram
catheters. There was no procedure-related mortality. All vascular
complications occurred in the first 25 procedures performed. There were
6 intraoperative procedural-related complications. These included
significant vascular complications (n = 4), one of whom required iliac
vein stenting, and 2 cardiac tamponade (one related to a
pop-phenomenon)—successfully treated by pericardiocentesis. Early
complications (n = 3) were 1 tamponade several hours post-procedure, 1
vascular complication, and 1 pericarditis. Late complications included
5 patients with severe pulmonary vein stenosis (all in first 27
patients) and 1 patient with gastroparesis. All complications were
successfully managed without persistent morbidity and occurred earlier
in our experience. This led to specific alterations in our vascular
access and ablation techniques. These include the use of a longer 14 Fr
sheath, through which the robotic sheath is more safely advanced. The
choice of ablation catheter and titration of power, particularly when
the catheter has a perpendicular orientation to the atrial wall, is
also important.

Conclusions:
The suggested modifications may make the system easier to use with the potential to reduce complications.

Full text at JOCE