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Updated: Dec 4, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Automated rhythm-based control of radiofrequency ablation close to the atrioventricular node: Preclinical, animal,
Darren A Hooks1, Remi Dubois2, Valentine Meillet2
1School of Medicine, University of Otago, Wellington, New Zealand; L'Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Pessac, Bordeaux, France; Cardiology Department, Hôpital Haut-Lévèque, Pessac, Bordeaux, France.
Background:
The risk of heart block during radiofrequency ablation of atrioventricular (AV) nodal reentrant tachycardia and septal accessory pathways is minimized by rapidly ceasing ablation in response to markers of risk, such as atrioventricular dissociation, fast junctional rhythm, PR interval prolongation, or 2 consecutive atrial or ventricular depolarizations. Currently this is done manually.
Objectives:
The objectives of this study were to build and test a control system able to monitor cardiac rhythm and automatically terminate ablation energy when required.
Methods:
The device was built from off-shelf componentry. Preclinical testing involved real-time input of electrogram/electrocardiogram data from 209 ablation procedures (20 patients) over slow (n = 19) and fast (n = 1) AV nodal pathways. The device response speed was compared with the human response speed. The device's ability to prevent heart block was tested in 5 sheep. First-in-human testing was then performed in 12 patients undergoing AV nodal reentrant tachycardia ablation.
Results:
Risk conditions necessitating shutoff of ablation (200 total; 111 preclinical and 89 first-in-human) were detected by the device with 100% sensitivity and 94% specificity, automatically terminating ablation while still allowing successful ablation in all patients. Device shutoff of ablation was always faster than human response (median difference 1.24 seconds). In each of 5 sheep, 40 consecutive attempts to cause heart block by ablating over the His bundle were unsuccessful because of automatic shutoff in response to rhythm change.
Conclusion:
Automated shutoff of ablation close to the AV node in response to markers of the risk of heart block is feasible with high accuracy as well as faster response than human response. The system may improve the safety of ablation near the AV node by preventing heart block.
Insights
A new automated system for radiofrequency ablation safely prevents heart block by rapidly detecting risk and stopping energy delivery. This technology offers faster response than manual methods, improving safety during procedures near the atrioventricular (AV) node.
Area of Science:
- Electrophysiology
- Medical device development
- Cardiac rhythm management
Background:
- Radiofrequency ablation for atrioventricular (AV) nodal reentrant tachycardia carries a risk of heart block.
- Current methods to mitigate this risk rely on manual cessation of ablation based on specific cardiac rhythm markers.
- This manual approach can be slower than optimal for preventing adverse events.
Purpose of the Study:
- To develop and validate a control system for automated monitoring of cardiac rhythm during ablation.
- To test the system's ability to automatically terminate ablation energy when indicators of heart block risk are detected.
- To compare the automated system's response time and efficacy against human operators.
Main Methods:
- The system was constructed using readily available components.
- Preclinical testing involved analyzing electrogram/electrocardiogram data from 209 ablation procedures in 20 patients.
- In vivo testing included evaluating the device's ability to prevent heart block in 5 sheep and initial human trials in 12 patients.
Main Results:
- The automated system demonstrated 100% sensitivity and 94% specificity in detecting risk conditions, automatically halting ablation.
- Device-initiated ablation shutoff was consistently faster than human response, with a median difference of 1.24 seconds.
- In sheep models, the system successfully prevented induced heart block during ablation attempts near the His bundle.
Conclusions:
- Automated ablation shutoff near the AV node is feasible, accurate, and faster than manual intervention.
- This system has the potential to significantly enhance the safety of ablation procedures in close proximity to the AV node.
- The technology may reduce the incidence of heart block during critical cardiac interventions.
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