Table 2.
General recommendations on RMN-guided catheter ablation.
| Recommendation | Level of consensus | Symbol | References |
|---|---|---|---|
| Staff | |||
| It is recommended to work with a dedicated clinical team to operate the RMN system and care for the patient | 24/27 (89%) |
|
11 |
| It is recommended that the clinical team is specifically trained to operate the RMN system | 26/27 (96%) |
|
11 |
| The clinical team may consist both off registered nurses, as well as registered technicians | 16/27 (59%) |
|
EO |
| Manufacturer's support may be considered to assist the staff to operate the RMN system. | 18/27 (67%) |
|
EO |
| Preparation and positioning of the patient | |||
| It is recommended that the patient is set up on the table by either dedicated nurses and/or technicians | 27/27 (100%) |
|
EO |
| Arm boards are recommended to support of the arms of the patient during the procedure | 22/27 (81%) |
|
EO |
| Other types of arm support may be considered (e.g., soft Velcro wraps, fixation with blanket, angled arm support and gel pads) | 14/27 (52%) |
|
EO |
| Positioning of patients for left-sided ventricular targets is not more challenging than for other targets. | 14/17 (82%) |
|
EO |
| It may be considered to iso-center the chamber of interest before catheters are inserted | 17/27 (63%) |
|
EO |
| It may be considered to perform pre-procedural imaging (either with CT or MRI) for anatomical and/or substrate representation, and image integration | 21/27 (78%) |
|
9, 10, 13, 14 |
| It is recommended to use a mechanical ventilator that is MRI compatible, or otherwise place it outside the 5 Gauss zone | 22/27 (81%), 5/5 (100%), respectively |
|
EO |
| Fluoroscopy | |||
| The Siemens and Philips fluoroscopy systems are compatible with RMN | 27/27 (100%) |
|
EO |
| It may be considered to take and store fluoroscopy images for use in Navigant software of the RMN system | 17/27 (63%) |
|
EO |
| It may be considered to use catheter overlay fluoroscopy images to reduce radiofrequency exposure | 16/27 (59%) |
|
EO |
| Point annotation on fluoroscopy is used by a minority to visualize structures or equipment | 13/27 (48%) |
|
EO |
EO, expert opinion; MRI, magnetic resonance imaging; RMN, robotic magnetic navigation.