Background-The present study examines the safety and feasibility of using a remote magnetic navigation system to perform endocardial and epicardial substrate-based mapping and radiofrequency ablation in patients with scar-related ventricular tachycardia (VT). Methods and Results-Using the magnetic navigation system, we performed 27 procedures on 24 consecutive patients with a history of VT related to myocardial infarction, dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, or sarcoidosis. Electroanatomic mapping of the left ventricular, right ventricular, and ventricular epicardial surfaces was constructed in 24, 10, and 12 patients, respectively. Completechamber VT activation maps were created in 4 patients. A total of 77 VTs were inducible, of which 21 were targeted during VT with the remotely navigated radiofrequency ablation catheter alone. With a combination of entrainment and activation mapping, 17 of 21 VTs (81%) were successfully terminated in a mean of 8.4Ϯ8.2 seconds; for the remainder, irrigated radiofrequency ablation was necessary. The mean fluoroscopy times for endocardial and epicardial mapping were 27Ϯ23 seconds (range, 0 to 105 seconds) and 18Ϯ18 seconds (range, 0 to 49 seconds), respectively. In concert with a manually navigated irrigated ablation catheter, 75 of 77 VTs (97%) were ultimately ablated. Four patients underwent a second procedure for recurrent VT, 3 with the magnetic navigation system. After 1.2 procedures per patient, VT did not recur during a mean follow-up of 7Ϯ3 months (range, 2 to 12 months). Conclusions-The present study demonstrates the safety and feasibility of remote catheter navigation to perform substrate mapping of scar-related VT in a wide range of disease states with a minimal amount of fluoroscopy exposure.
BACKGROUND
Pulmonary vein isolation (PVI) is recognized as a potentially
curative treatment for atrial fibrillation (AF). Ablation of complex
fractionated atrial electrograms (CFAEs) in addition to PVI has been
advocated as a means to improve procedural outcomes, but the benefit remains
unclear.
OBJECTIVE
To synthesize the available data testing the incremental benefit of
adding CFAE ablation to PVI.
METHODS
We performed a meta-analysis of controlled studies comparing the
effect of PVI with CFAE ablation versus PVI alone in patients with
paroxysmal and nonparoxysmal AF.
RESULTS
Of the 481 reports identified, 8 studies met our inclusion criteria.
There was a statistically significant increase in freedom from atrial
tachyarrhythmia (AT) with the addition of CFAE ablation (RR 1.15,
p=0.03). In the 5 reports of nonparoxsymal AF (3 randomized
controlled trials, one controlled clinical trial, and one trial using
matched historical controls), addition of CFAE ablation resulted in a
statistically significant increase in freedom from AT (n=112/181
[62%] for PVI+CFAE versus n=84/179
[47%] for PVI alone; RR 1.32, p=0.02). In
trials of paroxysmal AF (3 randomized controlled trials and one trial using
matched historical controls), addition of CFAE ablation did not result in a
statistically significant increase in freedom from AT (n=131/166
[79%] for PVI+CFAE versus n=122/164
[74%] for PVI alone; RR 1.04, p=0.52).
CONCLUSIONS
In these studies of patients with nonparoxysmal AF, addition of CFAE
ablation to PVI results in greater improvement in freedom from AF. No
additional benefit of this combined approach was observed in patients with
paroxysmal AF.
LAA dimensions predict strokes/TIAs in patients with AF. LAA assessment by MRI/MRA can potentially be used as an adjunctive tool for risk stratification for embolic events in AF patients.
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