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de Vries LJ, Hendriks AA, Yap SC, Theuns DAMJ, van Domburg RT, Szili-Torok T. Procedural and long-term outcome after catheter ablation of idiopathic outflow tract ventricular arrhythmias: comparing manual, contact force, and magnetic navigated ablation. Europace 2019; 20:ii22-ii27. [PMID: 29722857 DOI: 10.1093/europace/euy004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/08/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Currently, comparative data on procedural and long-term clinical outcome of outflow tract (OT) idiopathic ventricular arrhythmia (IVA) ablation with manual (MAN), contact force (CF), and magnetic navigation system (MNS) ablation are lacking. The aim of this study was to compare the procedural and long-term clinical outcome of MAN, CF, and MNS ablation of OT IVAs. Methods and results Seventy-three patients (31 MAN, 17 CF, and 25 MNS patients; consecutive per group) with OT IVA, who underwent catheter ablation in our centre were analysed. Procedural success rates (success at the end of the procedure), procedural data and long-term follow-up data were compared. Baseline patient demographics were comparable. Procedural success rates were similar (MAN 81%, 71% CF, and MNS 92%; P = 0.20). Median fluoroscopy time was shorter in the MNS group: MAN 29 (16-38), CF 37 (21-46), and MNS 13 (10-20) min (P = 0.002 for MNS vs. CF and MAN). The overall complication rate was: MAN 10%, CF 0%, and MNS 0% (P = 0.12). Median follow-up was: MAN 2184 (1672-2802), CF 1721 (1404-1913), and MNS 3031 (2524-3286) days (P <0.001). Recurrences occurred in MAN 46%, CF 50%, and MNS 46% (P = 0.97). Repeat procedures were performed in MAN 20%, CF 40%, and MNS 33% (P = 0.32). Conclusion Procedural and long-term clinical outcome of OT IVA ablation are equal for MAN, CF, and MNS. MNS has a favourable procedural safety profile due to the shorter fluoroscopy time compared with MAN and CF.
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Affiliation(s)
- Lennart J de Vries
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Astrid A Hendriks
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Sing C Yap
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Clinical Epidemiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Division of Electrophysiology, Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230, 3000 CA, Zuid-Holland, Rotterdam, The Netherlands
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Hügl B, Findeisen Z. The Use of Innovative Technologies to Guide Cardiac Procedures. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2012.9.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The advantages of intracardiac echocardiography (ICE) include shorter procedure times, reduced radiation exposure and the elimination of the need for general anesthesia. It is also effective in the safe performance of transseptal punctures. These have led to its increasing use in electrophysiology (EP) procedures. The use of ICE provides unrestricted access to the cardiac anatomy and guides interventional cardiac procedures by providing high-quality images of intracardiac structures and devices. As well as their use as imaging in catheter ablation of atrial fibrillation and other arrhythmias, ICE ultrasound catheters may be used in cardiac valve repair and the closure of atrial septal defects (ASDs). Integration of ICE catheters with electroanatomical mapping systems that construct three dimensional (3D) images have further increased the application of the technique. The use of magnetic navigation systems (MNS) have conferred further advantages including reduced exposure to fluoroscopy and increased operator comfort. This article presents four clinical cases and reviews clinical studies of these techniques.
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Affiliation(s)
- Burkhard Hügl
- Marienhaus Klinikum St Elisabeth Klinik, Neuwied, Germany
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Robotic magnetic catheter navigation as a first step in the automation of the ablation procedures for ventricular arrhythmia. Int J Cardiol 2018; 267:114-115. [PMID: 29861099 DOI: 10.1016/j.ijcard.2018.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/22/2022]
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Shauer A, De Vries LJ, Akca F, Palazzolo J, Shurrab M, Lashevsky I, Tiong I, Singh SM, Newman D, Szili-Torok T, Crystal E. Clinical research: remote magnetic navigation vs. manually controlled catheter ablation of right ventricular outflow tract arrhythmias: a retrospective study. Europace 2018; 20:ii28-ii32. [DOI: 10.1093/europace/eux382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ayelet Shauer
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Lennart J De Vries
- Department of Electrophysiology, Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Ferdi Akca
- Department of Electrophysiology, Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Jorge Palazzolo
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Mohammed Shurrab
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Ilan Lashevsky
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Irving Tiong
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - David Newman
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Tamas Szili-Torok
- Department of Electrophysiology, Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Eugene Crystal
- Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
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Lim PCY, Toh JJH, Loh JKXY, Lee ECY, Chong DTT, Tan BY, Ho KL, Ching CK, Teo WS. Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction. J Arrhythm 2017; 33:167-171. [PMID: 28607610 PMCID: PMC5459423 DOI: 10.1016/j.joa.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/15/2016] [Accepted: 08/26/2016] [Indexed: 01/21/2023] Open
Abstract
Background Percutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote controlled magnetic navigation (RMN) has been shown to reduce radiation exposure to patients and physicians compared with conventional manual (MAN) ablation techniques. Methods Catheter ablation for atrial fibrillation was performed utilizing RMN in 214 consecutive patients and MAN ablation techniques in 229 patients. We compared the fluoroscopy and procedural times between RMN and MAN catheter ablation of atrial fibrillation. Secondary objectives included comparing acute procedural success and short-term complication rates between both ablation strategies. Results Fluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; p<0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; p>0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; p=0.07). The rates of acute complications were similar in both groups (2.3% vs 4.8%, respectively; p=0.16). Conclusions In radiofrequency ablation of atrial fibrillation, RMN appears to significantly reduce fluoroscopy time compared with conventional MAN ablation, though at a cost of increased total procedural time, with comparable acute success rates and safety profile. A reduction in procedure and fluoroscopy times is possible with gaining experience.
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Aagaard P, Natale A, Briceno D, Nakagawa H, Mohanty S, Gianni C, Burkhardt JD, DI Biase L. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S38-44. [PMID: 26969222 DOI: 10.1111/jce.12938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.
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Affiliation(s)
- Philip Aagaard
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy.,Division of Cardiology, Stanford University, Stanford, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA.,EP Services, California Pacific Medical Center, San Francisco, California, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Dell Medical School, University of Texas, Austin, Texas, USA
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - Luigi DI Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
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ROY KARINE, GOMEZ-PULIDO FEDERICO, ERNST SABINE. Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review. J Cardiovasc Electrophysiol 2016; 27 Suppl 1:S45-56. [DOI: 10.1111/jce.12903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- KARINE ROY
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - FEDERICO GOMEZ-PULIDO
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
| | - SABINE ERNST
- Department of Cardiology; Royal Brompton and Harefield NHS Foundation Trust; London UK
- Biomedical Research Unit, National Heart and Lung Institute; Imperial College London; London UK
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Magnetic guidance versus manual control: comparison of radiofrequency lesion dimensions and evaluation of the effect of heart wall motion in a myocardial phantom. J Interv Card Electrophysiol 2015; 44:1-8. [PMID: 26123094 DOI: 10.1007/s10840-015-0023-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Magnetic navigation system (MNS) ablation was suspected to be less effective and unstable in highly mobile cardiac regions compared to radiofrequency (RF) ablations with manual control (MC). The aim of the study was to compare the (1) lesion size and (2) stability of MNS versus MC during irrigated RF ablation with and without simulated mechanical heart wall motion. METHODS In a previously validated myocardial phantom, the performance of Navistar RMT Thermocool catheter (Biosense Webster, CA, USA) guided with MNS was compared to manually controlled Navistar irrigated Thermocool catheter (Biosense Webster, CA, USA). The lesion dimensions were compared with the catheter in inferior and superior orientation, with and without 6-mm simulated wall motion. All ablations were performed with 40 W power and 30 ml/ min irrigation for 60 s. RESULTS A total of 60 ablations were performed. The mean lesion volumes with MNS and MC were 57.5 ± 7.1 and 58.1 ± 7.1 mm(3), respectively, in the inferior catheter orientation (n = 23, p = 0.6), 62.8 ± 9.9 and 64.6 ± 7.6 mm(3), respectively, in the superior catheter orientation (n = 16, p = 0.9). With 6-mm simulated wall motion, the mean lesion volumes with MNS and MC were 60.2 ± 2.7 and 42.8 ± 8.4 mm(3), respectively, in the inferior catheter orientation (n = 11, p = <0.01*), 74.1 ± 5.8 and 54.2 ± 3.7 mm(3), respectively, in the superior catheter orientation (n = 10, p = <0.01*). During 6-mm simulated wall motion, the MC catheter and MNS catheter moved 5.2 ± 0.1 and 0 mm, respectively, in inferior orientation and 5.5 ± 0.1 and 0 mm, respectively, in the superior orientation on the ablation surface. CONCLUSIONS The lesion dimensions were larger with MNS compared to MC in the presence of simulated wall motion, consistent with greater catheter stability. However, similar lesion dimensions were observed in the stationary model.
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Aagaard P, Natale A, Di Biase L. Robotic navigation for catheter ablation: benefits and challenges. Expert Rev Med Devices 2015; 12:457-69. [DOI: 10.1586/17434440.2015.1052406] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abraham P, Abkenari LD, Peters ECH, Szili-Torok T. Feasibility of remote magnetic navigation for epicardial ablation. Neth Heart J 2013; 21:391-5. [PMID: 23722429 PMCID: PMC3751027 DOI: 10.1007/s12471-013-0431-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Percutaneous epicardial mapping and ablation is an emerging method to treat ventricular tachycardias (VT), premature ventricular complexes (PVC), and accessory pathways. The use of a remote magnetic navigation system (MNS) could enhance precision and maintain safety. This multiple case history demonstrates the feasibility and safety of the MNS-guided epicardial approach in mapping and ablation of ischaemic VT, outflow tract PVCs, and a left-sided accessory pathway. All patients had previously undergone endocardial mapping for the same arrhythmia. MNS could present an advantage from more precise navigation for mapping and maintaining catheter stability during energy application.
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Affiliation(s)
- P Abraham
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 's Gravendijkwal 230, Ba 577, 3015 CE, Rotterdam, the Netherlands
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Hügl B, Velikan D, Buchter B, Findeisen Z. Managing difficult anatomy: remote-controlled ablation of atrioventricular nodal reentry tachycardia in a patient with agenesis of the inferior vena cava. Clin Res Cardiol 2013; 102:687-91. [DOI: 10.1007/s00392-013-0587-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
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12
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Remote magnetic navigation for mapping and ablation of right and left ventricular outflow tract arrhythmias. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parreira L, Cavaco D, Reis-Santos K, Carmo P, Cabrita D, Scanavacca M, Adragão P. Ablação de arritmias da câmara de saída do ventrículo direito e esquerdo com sistema de navegação magnética por controlo remoto. Rev Port Cardiol 2013; 32:489-95. [DOI: 10.1016/j.repc.2012.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 11/23/2012] [Accepted: 12/07/2012] [Indexed: 10/26/2022] Open
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SZILI-TOROK TAMAS, SCHWAGTEN BRUNO, AKCA FERDI, BAUERNFEIND TAMAS, ABKENARI LARADABIRI, HAITSMA DAVID, BELLE YVESVAN, GROOT NATASJADE, JORDAENS LUC. Catheter Ablation of Ventricular Tachycardias Using Remote Magnetic Navigation: A Consecutive Case-Control Study. J Cardiovasc Electrophysiol 2012; 23:948-54. [DOI: 10.1111/j.1540-8167.2012.02340.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BRADFIELD JASON, TUNG RODERICK, MANDAPATI RAVI, BOYLE NOELG, SHIVKUMAR KALYANAM. Catheter Ablation Utilizing Remote Magnetic Navigation: A Review of Applications and Outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1021-34. [DOI: 10.1111/j.1540-8159.2012.03382.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias--a systematic review. J Interv Card Electrophysiol 2011; 34:65-71. [PMID: 22180126 PMCID: PMC3342497 DOI: 10.1007/s10840-011-9645-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 11/13/2011] [Indexed: 11/18/2022]
Abstract
Objective Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT). Methods The National Library of Medicine’s PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system. Results The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0–17%). In ICMP and NICMP, recurrence rates of 0–30% and 14–50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures. Conclusions RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.
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Bauernfeind T, Akca F, Schwagten B, de Groot N, Van Belle Y, Valk S, Ujvari B, Jordaens L, Szili-Torok T. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias. Europace 2011; 13:1015-21. [PMID: 21508006 PMCID: PMC3120134 DOI: 10.1093/europace/eur073] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aims We aimed to evaluate the safety and long-term efficacy of the magnetic navigation system (MNS) in a large number of patients. The MNS has the potential for improving safety and efficacy based on atraumatic catheter design and superior navigation capabilities. Methods and results In this study, 610 consecutive patients underwent ablation. Patients were divided into two age- and sex-matched groups. Ablations were performed either using MNS (group MNS, 292) or conventional manual ablation [group manual navigation (MAN), 318]. The following parameters were analysed: acute success rate, fluoroscopy time, procedure time, complications [major: pericardial tamponade, permanent atrioventricular (AV) block, major bleeding, and death; minor: minor bleeding and temporary AV block]. Recurrence rate was assessed during follow-up (15 ± 9.5 months). Subgroup analysis was performed for the following groups: atrial fibrillation, isthmus dependent and atypical atrial flutter, atrial tachycardia, AV nodal re-entrant tachycardia, circus movement tachycardia, and ventricular tachycardia (VT). Magnetic navigation system was associated with less major complications (0.34 vs. 3.2%, P = 0.01). The total numbers of complications were lower in group MNS (4.5 vs. 10%, P = 0.005). Magnetic navigation system was equally effective as MAN in acute success rate for overall groups (92 vs. 94%, P = ns). Magnetic navigation system was more successful for VTs (93 vs. 72%, P < 0.05). Less fluoroscopy was used in group MNS (30 ± 20 vs. 35 ± 25 min, P < 0.01). There were no differences in procedure times and recurrence rates for the overall groups (168 ± 67 vs. 159 ± 75 min, P = ns; 14 vs. 11%, P = ns; respectively). Conclusions Our data suggest that the use of MNS improves safety without compromising efficiency of ablations. Magnetic navigation system is more effective than manual ablation for VTs.
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Affiliation(s)
- Tamas Bauernfeind
- Department of Cardiology, Thoraxcenter, Clinical Electrophysiology, Erasmus MC, Postbus 2040, S Gravendijkwal 230, Kamer BD416, 3000 CA Rotterdam, The Netherlands
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Burkhardt JD, Di Biase L, Natale A. Remote magnetic navigation for atrial fibrillation ablation: is 'As Good as Manual' good enough. Europace 2010; 13:5-6. [DOI: 10.1093/europace/euq380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schwagten BKR, Szili-Torok T, Rivero-Ayerza M, Jessurun E, Valk S, Jordaens LJLM. Usefulness of remote magnetic navigation for ablation of ventricular arrhythmias originating from outflow regions. Neth Heart J 2009; 17:245-9. [PMID: 19789687 PMCID: PMC2711250 DOI: 10.1007/bf03086255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Monomorphic ventricular tachycardia (VT) and symptomatic monomorphic PVCs originating from the region of the right and left outflow tracts are increasingly treated by radiofrequency (RF) catheter ablation. Technical difficulties in catheter manipulation to access these outflow tract areas, very accurate mapping and reliable catheter stability are key issues for a successful treatment in this vulnerable region. VT ablation from the aortic sinus cusp (ASC) in particular carries a significant risk of perforation, of creating left coronary artery injury and of damage to the aorta and the aortic valve.This case series describes RF ablation of VT originating in the outflow region using the remote magnetic navigation system (MNS). Potential advantages of the MNS are catheter flexibility, steering accuracy and reproducibility to navigate to a desired location with a low probability of perforating the myocardium. This report supports the idea of using advanced MNS technology during RF ablation in regions which are difficult to reach and thin walled, such as parts of the outflow tract and the ASC. (Neth Heart J 2009;17:245-9.).
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Affiliation(s)
- B K R Schwagten
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
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