Long-Term Efficacy and Impact on Mortality of Remote Magnetic Navigation Guided Catheter Ablation of Ventricular Arrhythmias

Abstract

Remote magnetic navigation (RMN) facilitates ventricular arrhythmia (VA) ablation. This study aimed to evaluate the long-term efficacy of RMN-guided ablation for ventricular tachycardia (VT) and premature ventricular contractions (PVC). A total of 176 consecutive patients (mean age 53.23 ± 17.55 years, 37% female) underwent VA ablation for PVC (132 patients, 75%) or VT (44 patients, 25%). The cohort consisted of 119 patients (68%) with idiopathic VA, 31 (18%) with ischemic (ICM), and 26 (15%) with dilated cardiomyopathy (DCM). VA recurrence was observed in 69 patients (39%, mean age 51.71 ± 19.91 years, 23% female) during a follow-up period of 5.48 years (first quartile 770.50 days, second quartile 1101.50 days, third quartile 1615.50 days). Left ventricular ejection fraction <40% lead to a significantly increased risk for VA (p = 0.031*). Multivariate analyses found DCM to be an independent predictor (IP) for VA recurrence (p < 0.001*, hazard ratio (HR) 3.74, confidence interval (CI) 1.58–8.88). ICM resulted in a lower increase in VA recurrence (p = 0.221, HR 1.49, CI 0.79–2.81). Class I/III/IV antiarrhythmic drug therapy (AADs) was also identified as IP for recurrence (p = 0.030*, HR 2.48, CI 1.11–5.68). A total of 16 patients (9%) died within the observational period. RMN-guided ablation of VA lead to acceptable long-term results. An impaired LV function, DCM, and AADs were associated with a significant risk for VA recurrence. Personalized paths are needed to improve efficacy and outcome.

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

“…On the contrary, in previously published data and our study results, there is no evidence of the significant implication of the CFS catheter on safety during ventricular RFCA, independent of the presence of structural heart disease, arrhythmia localization, or fluoroscopy use [14,15,18,[24][25][26]. Novel techniques are introduced in cardiac electrophysiology [27]. The use of non-fluoroscopic imaging during catheter ablation is more frequently used than before [28,29].…”

Radiofrequency ablation of premature ventricular contractions guided by robotic magnetic navigation combined with pattern matching filter

“…Radiofrequency ablation guided by RMN is a safe and effective way to treat PVCs 2,14–17 . The omnidirectional flexible magnetic catheter is not restricted by fixed curves and can reach most any challenging anatomical position 3 .…”

“…Radiofrequency ablation therapy guided by robotic magnetic navigation (RMN) is a well-studied and acknowledged treatment for premature ventricular contractions (PVCs) and other complex arrhythmias with high efficacy, fewer complications and less X-ray exposure versus traditional manual catheter ablation, and a short technology learning curve. [1][2][3][4][5][6][7] Since 2013, our center has been employing RMN combined with three-dimensional electroanatomic mapping system (CARTO, Biosense Webster Inc) in ablation therapy across a wide range of complex arrhythmias including PVCs and ventricular tachycardia. During our center's early experience, the mapping aspect of PVCs procedures presented challenges.…”

Magnetically Actuated Continuum Medical Robots: A Review

“…Results show improved safety, precision, efficacy, and outcome. [ 128,129 ] Recently, Stereotaxis Inc. released the Genesis system with a lighter, faster, and more flexible architecture with smaller magnets that rotate along their center of mass (Figure 6b). The entire system is significantly smaller, allowing for greater access to the patient and allowing for unprecedented responsiveness to the physician's command.…”