Initial experience, safety and feasibility using remote access or onsite technical support for complex ablation procedures: Results of the REMOTE study

Electroanatomical mapping (EAM) systems are essential for treatment of cardiac arrhythmias. The EAM system is usually operated by qualified staff or field technical engineers (FTE) from the control room. Novel remote support technology allows for remote access of EAM via online services. Remote access increases the flexibility of the electrophysiological lab, reduces travel time and overcomes hospital access limitations especially during the COVID-19 pandemic. Here we report on the feasibility and safety of EAM remote access for cardiac ablation procedures. Mapping and ablation were achieved by combining the EnsiteXTM EAM system and the integrated EnsiteTM Connect Remote Support software, together with an integrated audiovisual solution system for remote support (Medinbox). Communication between the operator and the remote support was achieved using an incorporated internet-based common communication platform (ZoomTM), headphones and high-resolution cameras. We investigated 50 remote access assisted consecutive electrophysiological procedures from 09/2022 to 02/2023 (remote group). The data was compared to matched patients (n=50) with onsite support from the control room (control group). The median procedure time was 100min (76, 120) (remote) vs. 86min (60, 110) (control), p=0.090. The procedural success (both groups 100%, p=0.999) and complication rate (remote: 2%, control: 0%, p=0.553) were comparable between the groups. Travel burden could be reduced by 11,280 km. Remote access for EAM was feasible and safe in this single center study. Procedural data were comparable to procedures with onsite support. In the future, this new solution might have a great impact on facilitating electrophysiological procedures.