The cardiac program at Northeast Georgia Medical Center began in August 2002, with the opening of the Ronnie Green Heart Center and the start of Cardiovascular Surgery and Interventional Cardiology. The Cardiology Department began the program with a desire to achieve the highest level of clinical excellence in outcomes, quality, and technologically superior care. The goal has been to build a heart center that would perform at a national level. It was with this same focus on excellence that the Stereotaxis MNS was selected for the newest cardiac laboratory. In planning for the new labs, Interventional Cardiology and EP determined that the Stereotaxis system had great promise for improved outcomes and success with complex interventions and catheter ablations. Over the past year, the system s capabilities have exceeded our expectations, and the system is now utilized for almost all catheter ablations. A case study is presented to highlight our experience with the MNS.

Case Study

A 55-year-old man with coronary artery disease and normal left ventricular systolic function had a three-year history of symptomatic atrial fibrillation (AF) with early recurrence following sotalol therapy. Amiodarone had resulted in satisfactory suppression, but was not well tolerated. The patient elected to proceed with catheter ablation. This case was the first AF ablation performed with Stereotaxis magnetic navigation at Northeast Georgia Medical Center. Our approach for AF ablation at NGMC is outlined as follows. Pre-procedural imaging of the left atrium (LA) and pulmonary veins (PV) is performed with CT or cardiac MRI, and a transesophageal echo is done prior to the ablation. The ablation lesion set includes encircling lesions around the left and right pulmonary veins in an antral location with additional left atrial ablation individualized for each patient. Three-dimensional electroanatomic mapping (CARTO ^® electroanatomical mapping system, Biosense Webster, Inc., Diamond Bar, California) is used with guidance from intracardiac echocardiography (ICE) to further visualize the pulmonary vein anatomy. In addition, a circumferential mapping catheter (LASSO circular mapping catheter, Biosense Webster, Inc.) is used with the goal of PV isolation.

Cardiac CT scanning in this patient revealed a common left PV ostium and two separate right PV ostia (Figure 1). After transseptal access into the LA, the PVs were visualized on ICE, and the location of the LASSO at the PV os is verified. Next, three-dimensional mapping of the LA and PVs is performed. The mapping and ablation catheter (NaviStar RMT, Biosense Webster, Inc.) is maneuvered entirely remotely from the control room via the Navigant software (Stereotaxis, Inc., St. Louis, Missouri), which provides the interface between the electrophysiologist and the MNS. Fluoroscopic images are captured and saved in the Navigant window, and the catheter is directed from this information. With the click of a mouse and use of a joystick, the catheter is maneuvered to locations in the heart selected from the Navigant screen. The MNS permanent magnets provide direction for the catheter, and the catheter advancement system (CAS) advances and retracts the catheter. A crucial feature of the system is the MNS integration with the CARTO system. Points of interest on the CARTO map can be transferred to the Navigant software, and the catheter may be remotely directed to these points at the operator s discretion.