The Hindu : Tamil Nadu / Chennai News : Cardiac interventions through remote control

Online edition of India's National Newspaper
Monday, Aug 01, 2005

Tamil Nadu

Tamil Nadu - Chennai

Cardiac interventions through remote control

M. Dinesh Varma

"We always compare the situation to modern aircraft ... no matter how sophisticated the level of automation, we feel safer with a good pilot in the cockpit."

CHENNAI: Complex tasks such as guiding a catheter to the site of arterial blocks or steering a guidewire-based device along the vascular system could now be a matter of pushing buttons at a computer console that is insulated from radiation fields.

A computer enhanced navigation system for minimally invasive interventional medicine developed by U.S.-based Stereotaxis Inc., is being seen by interventional cardiologists and electrophysiologists as the Cathlab of the future. The Niobe system of magnetic assisted intervention integrates navigation software with imaging on a digital platform to deliver therapy. "The results from procedures on 1,000 case studies have been exciting. We have either eliminated or significantly curtailed the standard deviation in the existing interventional procedures," said Jim Accord, Regional Director of Stereotaxis which developed the technology.

Mr. Accord was in Chennai on Sunday for a presentation before a select gathering of leading interventional cardiologists and electrophysiologists from all over India at Madras Medical Mission. Stereotaxis is looking at India, particularly Chennai as one of the important markets, because of the readiness of the healthcare infrastructure to invest in new technology, he said. It already has completed installations of the digital cathlab at top medical institutions in the U.S., Europe and West Asia.

Ulhas Pandurangi, electrophysiologist at Madras Medical Mission, said the backdrop of the having a presentation on the new technology had been the 15-20 per cent failure rates in interventional cardiology procedures. Experts the world over seemed to concur that procedures could be more successful with better hardware assistance.

He said another important reason for failure of Percutaneous Coronary Intervention procedures had been inability to reach a desired spot and stay put at that spot, however dexterous the surgeon was.

The new technology allows the operator to sit in the control room, not exposed to radiation, and manoeuvre remotely the guide-wires and the catheters and cross the lesions effectively to reach the desired region of the heart.

"Often, we realise that things are going wrong in the middle of a procedure and it is cumbersome to negotiate an alternative pathway for a guidewire device," said Dr. Ulhas.

Cost effective

The Rs. 5 crore MAI equipment involves a magnetic field of specified direction and magnitude, positioned externally to the patient and a tiny magnet in the tip of the interventional device.

The result is an alignment of the distal tip of the magnet with the field direction — literally steering catheters and guidewires through the heart and the coronary vascular system. Speed and precision could also bring down treatment costs.

Magnets are rotated to change field orientation as an automatic advancement system automatically controls catheter advancement and retraction.

The physician has continuous, 360-degree, omni-directional control regardless of how many turns or how far the distal tip must travel to reach its target. Magnetic control allows the physician to reshape the tip in vivo without removing or replacing the wire.

The future applications with this technology could include catheter-based treatment for Atrial Fibrillation ablation and Chronic Total Occlusion, the management of which had been seriously limited by difficulties in controlling the movement of the catheter.

But in providing what Mr. Accord describes as a `level playing field' for interventionists, how much would the technology take away from the skill set of physicians? "We always compare the situation to modern aircraft ... no matter how sophisticated the level of automation, we feel safer with a good pilot in the cockpit," said Mr. Accord.

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