Pioneering Procedures at Genesis

Catheter robotics system helps map heart rhythms

 

Another first-in-the-nation procedure is underway in a Genesis cardiac catheterization lab.

The patient, an 18-year-old teen with an irregular heartbeat, is set to undergo radiofrequency catheter ablation. Quite simply, a hot-tip catheter will be placed at the site of her heart rhythm disturbance to cauterize or burn the tissue that's making the heart's electrical wiring system go haywire.

It's a procedure that has been performed many times before by Genesis Heart Institute electrophysiologist Michael Giudici, M.D.

However, on this day, he does it with a pioneering twist.

In this national first, he will use the catheter robotic system  to perform the mapping study that pinpoints the location of the heart rhythm problem.

Typically, a mapping procedure requires a physician to stand beside the patient, directing the catheters by hand and using x-ray fluoroscopy to determine the anatomical positioning. Such studies can be quite long and physically arduous for the physician, who wears 30 pounds of protective gear and risks significant radiation exposure.

"The problem is our field has developed into a field of 5, 6 and 7-hour procedures, all while standing wearing 30 pounds of lead at the patient's bedside," Dr. Giudici says. "These are physically taxing for the physician, with a lot of radiation exposure and stress on backs and knees. The longer the procedure goes on, the higher the risk of fatigue and operator error."

To address the problem, Catheter Robotics Inc. of New Jersey has developed a remote catheter system that uses robotic technology to give physicians "a hand" in maneuvering catheters throughout the body's delicate venous system -- all while standing or sitting outside of the x-ray field.

The technology works like this: Once the catheter has been inserted into the body and the heart, the physician can put the catheter onto the docking station of a robot arm, and then with the remote control, can manipulate the catheter on the robotic arm from a location up to 100 feet away from the radiation zone. The system uses standard EP study catheters, which can be dismounted and mounted with ease.

"This technology will allow the physician to control the mapping -- and potentially the catheter ablation -- from a distance," Dr. Giudici says. "The physician can be sitting in a chair and outside the field of radiation and even in another room or control room during the procedure. Doctors can do the procedure without risking back problems, early cataracts and cancer from radiation exposure.

"The benefit to the patient is a fresher doctor. The benefit to the doctor is reduced health risks; he or she won't have to have back surgery and retire early."

The catheter robotic system serves a very different function than the da Vinci Surgical System at Genesis. With the da Vinci, physicians sit at a console several feet away from the patient and use a remote control to navigate robotic arms through small incisions and operate in very small confines of the body, such as for a prostatectomy or a hysterectomy.

"Some robotic systems essentially have the purpose of making the physician's hands smaller and able to operate in smaller places," Dr. Giudici explains. "Well, we already have tiny catheters that go up to the heart to do our work. The aim of this catheter robotic system is to help reduce the wear and tear on the physicians and enable them to do the procedure outside the field of radiation."  

In the United States, the catheter robotic system is still in the investigational stage. For this reason, Dr. Giudici could only use the remote catheter manipulation system for mapping the heart.

'"The FDA is not allowing us to use it yet for the actual ablation," he explains. "The FDA wants us to start out by showing we can use the robotics to navigate catheters safely in the heart."
  

Genesis is among eight U.S. hospitals that are part of the study, along with much larger hospitals like Massachusetts General in Boston and Johns Hopkins in Baltimore.

As an avid researcher, Dr. Giudici is no stranger to national and even world firsts -- a fact that has given his Genesis Heart Institute patients access to new technology and treatments long before the rest of the nation.  In fact, his teen-age patient was the first of 180 patients who will be tested with the device over the next six to eight months.

" It takes an entire team. The reason we're able to do this is because we have a dedicated staff, and our Institutional Review Board at Genesis does such a great  job," Dr. Giudici says. "We provide a high level of care at Genesis, and we're known as a top-level research center. That's why we're sought out for these kinds of research projects."