Fall 2007

Magnetic Navigation Improves Catheter Ablation

The electrophysiology (EP) lab at UCSF's Heart and Vascular Center is the only facility in California to offer radiofrequency catheter ablation using a leading-edge magnetic navigation system for patients with cardiac arrhythmias. Since the lab opened one year ago, UCSF electrophysiologists have seen hundreds of patients from around the world.

"With the magnetic catheter navigation system, we can move the catheter with greater precision and less risk than traditional ablation procedures," says Jeffrey Olgin, M.D., chief of the UCSF Cardiac Electrophysiology and Arrhythmia Service. "Because the complication rate is so minimal, ablation is a better alternative to drugs for many patients with certain types of arrhythmias."

The $3 million Stereotaxis Niobe Magnetic Navigation System represents the future of catheter ablation treatment, says Olgin. The system can be used to treat a wide variety of arrhythmias, including atrial flutter, atrial fibrillation, atrial tachycardia, other supraventricular tachycardias, Wolff-Parkinson-White syndrome and ventricular tachycardia.

Atrial fibrillation is the most common arrhythmia, afflicting more than two million Americans, according to the American Heart Association. Abnormal electrical signals from the atria can lead to fast or irregular heartbeats, dizziness, palpitations, chronic fatigue and congestive heart failure. Atrial fibrillation is also a leading cause of stroke.

Although the success rates of traditional ablation procedures and magnetic navigation are the same, roughly 85 percent, magnetic navigation is faster, yields fewer complications and is more accurate, says Olgin. The new procedure takes less than three hours compared with the traditional four-hour procedure. Another advantage is reduced exposure to X-ray radiation for both the physician and the patient.

During traditional ablation procedures, a catheter is manually manipulated inside the chamber of the heart. Since the catheter is stiff, there is some risk of heart perforation during manipulation. With the magnetic navigation system, the physician remotely guides the catheter from a separate control room, using computer software that provides navigational control of catheters and displays a 3-D model of the patient's heart. In addition, the new catheter is floppy, eliminating the risk of heart perforation.

In the operating room, the patient lies between a pair of two-ton magnets, which create a computer-controlled magnetic field around the patient's chest. The tip of the catheter contains micromagnets, and physicians can guide the catheter in very precise movements, as little as one millimeter at a time and 360 degrees in any direction. An electrode on the tip of the catheter creates an electrical map of the heart and locates the tissue causing the irregular electrical signal.

"We have all the latest computerized mapping systems," says Olgin. "We can take a CT scan before the patient arrives, so that we can see their heart on the computer screen. It's a virtual representation of the person's heart for us to navigate in. With our mapping systems and the magnetic navigation system, this is the probably the most technologically advanced EP lab in the country."

Once the problem tissue is located, the physician clicks a computer mouse and the catheter automatically moves to the tissue. Using foot pedals, the physician cauterizes the tissue via radiofrequency energy emitted from the tip of the catheter.

The new EP lab not only has state-of-the-art equipment, it has a more comfortable, patient-friendly environment than the previous EP lab. "The suite is designed to be a patient-friendly center," says Olgin. "We now have music in the lab and it's a nice place for patients to be."

Last year's opening of the new EP lab marked the 25th anniversary of the first radiofrequency catheter ablation, which was performed at UCSF by electrophysiology expert Mel Scheinman, M.D., in 1981.

"We've always been leaders in the field of electrophysiology," says Olgin. "Ablation was invented here, and we've always been on the cutting edge and leading the clinical application. The magnetic navigation system here at UCSF is just another example of that."

To contact Dr. Jeffrey Olgin, call (415) 476-5706.

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