Magnetic Navigation in the EP Lab is Now a Reality

Named Lexington, Kentucky's Hospital of Choice for the last five years, Central Baptist Hospital strives to maintain the latest and greatest in technology at its facility. Since opening in 1954, Central Baptist Hospital has been committed to finding better ways to serve the people of Kentucky's Bluegrass area. What began nearly 50 years ago as a 173-bed community hospital, is now a 371-bed, major medical research and education center. Today, Central Baptist has one of the busiest and most respected heart programs in the state, the Baptist Heart Institute. Our leadership and commitment to healthy cardiac care began in 1967, when we opened Kentucky's first coronary care unit. We performed our first catheterization procedure in 1980, and our first open-heart surgery in 1982. However, coronary care technology continues to change rapidly and constantly. Since less invasive procedures, more accurate tests and groundbreaking medicines appear on the horizon almost daily, the Baptist Heart Institute strives to continuously house the very latest diagnostic, surgical and laboratory facilities for cardiac care, including our electrophysiology (EP) labs. We presently perform more than 450 general EP studies, 350 ablations, and 600 pacemaker/defibrillator procedures each year. Shortly after the Baptist Heart Institute moved to a new building in 2000, with two EP lab suites, the sheer volume of EP procedures soon outgrew the labs and technologies in place. So, we began the search to find a new EP lab. When researching various technologies to determine what to purchase, we identified several needs and issues to be addressed by the new technology. In addition to finding a lab that would better fit our ever-increasing volume of procedures performed, we needed to find a system that provided high-quality images, while reducing radiation dosages and improving workflow in the EP lab. Finally, the new lab needed to be able to perform research on new types of ablations and diagnostic mapping without sacrificing the ability to perform general EP procedures. During this time, we were offered the opportunity to conduct research protocols for a revolutionary, new system for interventional medicine. The system, a combination of AXIOM Artis dFC and Stereotaxis, Inc.'s NIOBE magnets enabled the opportunity for research, and addressed each of the other issues as well. It was a logical choice for the Baptist Heart Institute. The NIOBE Magnetic Navigation System has recently been cleared for marketing in the United States, and we are one of the first hospitals in the world to install and utilize this revolutionary technology. We've had the system in place for just over a month. Using it, we've already performed several sophisticated procedures, including mapping, placing of guidewires for biventricular pacemakers and studies involving ablations of supraventricular tachycardia under an FDA-approved Investigational Device Exemption using an investigational magnetic catheter. On the flip side, we've also been able to perform general diagnostic EP studies and regular pacemaker and defibrillator procedures with no problems. Together, Siemens Medical Solutions and Stereotaxis, Inc. unveiled the world s first digital imaging system designed to work with a magnetic navigation system for interventional medicine. The Artis dFC Magnetic Navigation System is the first catheter navigation system of its kind in the world. The system integrates Siemens most advanced digital fluoroscopic imaging system, the AXIOM Artis dFC (Flat Panel Detector System), with Stereotaxis NIOBE Magnetic Navigation System, to direct and digitally control catheter- and guidewire-based devices along complex paths within the heart and coronary vasculature. Magnets external to the body control the magnetic-tipped catheter and guidewire devices. This approach, which allows for 360 º rotation of the catheter, has the potential to provide greater precision and better movement than manual methods. The system uses computer-controlled permanent magnets for orienting the magnetic tip of specially designed catheters and guidewires. This interventional technique allows cardiologists to navigate catheters and guidewires to designated target sites in the heart, and coronary vasculature. Perhaps the strongest feature of the new system is the remote steering. By utilizing magnets to control the catheter device rather than manually controlling it, we can steer the catheter within the heart. Problems associated with manual catheter steering and positioning are a matter of the past, as the magnets offer the potential to enable more exact movements. Obviously, the switch from manual to remote steering has been a major paradigm shift. Before, the procedures were very tactile and hands-on. Now the procedures can be executed remotely; the magnetic tip of the catheter provides an opportunity to maintain stability for a longer period of time, and the fluoroscopic image can be used to determine when there is better contact within the heart at the desired location. At the Baptist Heart Institute, we have already utilized the system to perform procedures where a catheter or guidewire has been placed in a location that we potentially wouldn t have been able to do with manual steering, because of the limitations in manual dexterity. With this increased ability, we are confident that we can possibly increase the success rate of even the most difficult EP procedures. Also, the system s remote capabilities give clinicians the potential to perform procedures from the control room by using a joystick As compared to four weeks ago, we're already experiencing better workflow in our EP suites. Previously, our EP physicians had to work long hours as a result of working in a single EP lab. Now, cases can be completed more quickly, and the patients don t have to wait for several hours before their EP work can be completed. In addition, the flat screen monitors on the system s boom are much easier to swing around than old heavier, more awkward monitors, making it easier to complete procedures. The learning curve of the system is short. Our physicians and lab personnel appreciate both the simple-to-use and easy-to-learn features of the system. Specifically, the computer software interface that allows for the catheter s remote movement is very intuitive. All of these features help to free up our physicians and lab personnel to do more of what they should be doing focusing directly on the patient. With the flat panel detector technology of the system, image quality is dramatically better. The gray tones and white tones are amazing, the clarity of the heart border is increased. The integration of advanced fluoroscopic technology with a remote catheter control allows clinicians at Central Baptist to better leverage the imaging information to ensure the catheter is positioned properly. This combination of better image quality and the potential for more precisely guided catheters enables us to complete procedures more quickly, which may translate to less radiation exposure for the EP patient. The system also improves upon the use of pulse fluoroscopy to further reduce radiation dosages and exposure to the patient. While it s too soon to comment on improvements in the quality of care with the system, we have been pleased thus far and expect to see great results. Still in the investigational stages, we anticipate improved patient care for simple ablations and general EP work. We believe there eventually will be an even greater increase in patient care and positive outcomes in those patients when addressing the challenges of more difficult ablations. In those situations, we are confident the success rates may increase, and the complication rates decrease. With the system s features offering the potential for more precise and accurate procedures, we feel patient outcomes may be significantly improved. Our hope and belief is that one day this type of system will facilitate EP work so that success rates for all physicians in the field can be standardized at the highest rate. The AXIOM Artis dFC provides digital images, which can be easily stored onto a CD-ROM or on our ACOM.Net image distribution network, and retrieved at a moment s notice. These easier storage capabilities allow us to get to the images and make additional patient treatment decisions more quickly, which can lead to better patient outcomes. The Baptist Heart Institute continuously searches for the newest tools and technologies that enable faster response and greater efficiency in treating cardiac patients. As medical technology continues to grow and improve, we will continue to be among its leaders and utilize the newest technologies like the AXIOM Artis dFC Magnetic Navigation System to provide the highest quality of patient care and highest rates of positive patient outcomes.