Initial Experience with Catheter Ablation Using Remote Magnetic Navigation in Adults with Complex Congenital Heart Disease and in Small Children

Background-Improvement in outcome of infants born with congenital heart defects has been accompanied by an increasing frequency of late arrhythmias. Ablation is difficult because of multiple tachycardias in the presence of complex anatomy with limited accessibility. We report on remote-controlled ablation using magnetic navigation in conjunction with 3D image integration in patients with previous intra-atrial baffle procedures. Methods and Results-Thirteen patients (8 male; age, 30.5Ϯ8 years) with supraventricular tachycardia (SVT) underwent catheter ablation. Group A had a medical history of a Mustard or Senning operation, whereas group B had undergone total cavopulmonary connection. A total of 26 tachycardias were treated in 17 procedures (median cycle length of 280 ms). Group A patients had more inducible SVTs than group B, and all index SVTs were located in the remainder of the morphological right atrium in all but 1 patient. Retrograde access through the aorta was performed and led to successful ablation, using magnetic navigation with a very low total radiation exposure (median of 3.8 minutes in group A versus 5.9 minutes in group B). Only 1 of 13 patients continued to have short-lasting SVTs despite 3 ablation procedures during a median follow-up time of Ͼ200 days. Conclusions-Remote-controlled catheter ablation by magnetic navigation in combination with accurate 3D image integration allowed safe and successful elimination of SVTs, using an exclusively retrograde approach, resulting in low radiation exposure for patients after intra-atrial baffle procedures (Mustard, Senning, or total cavopulmonary connection). (Circ Arrhythm Electrophysiol. 2012;5:131-139.)

Section: Discussionmentioning

confidence: 99%

Section: Reduced Radiation Exposure With Remote Navigationmentioning

confidence: 99%

Remote-Controlled Magnetic Navigation and Ablation With 3D Image Integration as an Alternative Approach in Patients With Intra-Atrial Baffle Anatomy

Ernst

Babu‐Narayan

Keegan

et al. 2012

“…However, from our perspective RMN helped surmount 3 major hurdles seen in complex adult patients with CHD, namely, limited access to the target chamber, extensive atrial enlargement, and extensive wall thickness. 9,10,[17][18][19] Limited access is the consequence of complex intra/extracardiac anomaly and presence of intra-atrial baffles or artificial materials. We selected a retrograde aortic access and superior retrograde venous access for group C patients in our study.…”

Section: Difficulties In Adult Chd Ablation and The Role Of Rmnmentioning

confidence: 99%

Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease

Ueda

Suman-Horduna

Mantziari

et al. 2013

Background-Remote magnetic navigation-guided ablation with 3-dimensional (3D)-image integration could provide maximum benefit in patients with complex anatomy. We reviewed supraventricular tachycardia (SVT) ablation in adult patients with congenital heart disease to assess the contribution of these technologies. Methods and Results-One hundred fifty-four SVT ablation procedures (228 SVTs) using a 3D-electroanatomic mapping system in 116 adult patients with congenital heart disease (mean age, 41; 76 male) were classified into 3 groups: Group A, manual mapping/ablation (n=60 procedures); Group B, remote magnetic navigation-guided mapping/ablation with normal femoral vein access (49)

“…In patients with congenital heart disease and anatomic variants, MNS can be a useful tool for reaching the areas otherwise inaccessible with conventional catheters. 12,13 …”

Section: Miyazaki Et Al Conventional Versus Mns Ablation For Af 587mentioning

confidence: 99%

Remote Magnetic Navigation With Irrigated Tip Catheter for Ablation of Paroxysmal Atrial Fibrillation

Miyazaki

Shah²,

Xhaët³

et al. 2010

Background— The remote magnetic navigation system (MNS) has been used with a nonirrigated magnetic catheter for atrial fibrillation (AF) ablation. The objective of this study was to evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for index pulmonary vein isolation (PVI) in patients with paroxysmal AF (PAF). Methods and Results— Between January 2008 and June 2009, 30 consecutive patients with drug-resistant PAF underwent circular mapping catheter-guided PVI with MNS (MNS group). The outcomes were compared retrospectively with those of a conventional hand-controlled ablation technique during the same period in 44 consecutive patients (manual group). All 4 pulmonary veins were successfully isolated in both groups except in 4 patients in the MNS group. Radiofrequency and procedure duration were higher in the MNS group (60±27 versus 43±16 minutes; P =0.0019) than in the manual group (246±50 versus 153±51 minutes; P <0.0001). In the patients who underwent only PVI, total fluoroscopic time also was longer in the MNS group than in the manual group (58±24 versus 40±14 minutes; P =0.0002). At 12-month follow-up after a single procedure, 69.0% of the patients in MNS group and 61.8% of patients in manual group were free of atrial tachyarrhythmia without antiarrhythmic drugs. There was no significant difference in the atrial tachyarrhythmia-free survival between the 2 groups ( P =0.961). Cardiac tamponade occurred in 1 patient in the manual group. Conclusions— In patients with PAF, MNS-guided PVI with the newly available irrigated tip magnetic catheter backed up with manual ablation whenever required is feasible. However, it requires longer ablation, fluoroscopy, and procedural times than the conventional approach in the early experience stage.