Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large‐scale single‐center study

Abstract

Background Remote magnetic navigation (RMN)‐guided ablation has become an inspiring method of catheter ablation for tachyarrhythmias. Hypothesis Data from a large‐scale single center may provide further insight into the safety of and the learning curve for RMN‐guided ablation. Methods A total of 1003 catheter ablation procedures using RMN for conditions including supraventricular ventricular tachycardia, atrial tachyarrhythmias, and premature ventricular contraction/ventricular tachycardia (PVC/VT) were retrospectively analyzed from an ablation registry. Procedural outcomes, including procedure time, mapping time, X‐ray time, and RF time, were assessed. The complications were classified into two categories: major and minor. A subanalysis was used to illustrate the learning curve of RMN‐guided ablation by assessing procedure time and total X‐ray time of 502 atrial fibrillation (AF) ablation procedures. Results Among these procedures, 556 (55.4%) were AF and 290 (28.9%) were PVC/VT. Electrical pulmonary vein isolation was achieved in 99.0% of AF procedures, and acute success reached 90.3% in PVC/VT procedures. The overall complication rate was 0.5%. In the subanalysis of AF procedures, the overall procedure time and X‐ray time of procedures were short (125.9 ± 54.6 and 5.3 ± 3.9 minutes, respectively) and proceeded to decrease from the initial 30 procedures to about 300 procedures, where the learning curve reached plateau, demonstrating maximum procedure efficiency. Conclusions RMN‐guided ablation is safe, as verified by very low overall complication rate and reduced X‐ray time. In our study, even the first AF procedures had a relatively low procedure time and total X‐ray time, and procedure efficiency improved during the learning curve.

Catheter ablation for ventricular arrhythmias using remote magnetic navigation in patients with reduced ejection fraction

“…Our study reports procedural success rate of 92.3% and 88.1% in patients with and without rLVEF respec-tively, which is similar to recent studies published in the literature [14]. Success rates in similar studies vary between 80% [15] and 100% [16].…”

Utilization of steerable sheath improves the efficiency of atrial fibrillation ablation guided by robotic magnetic navigation compared with fixed‐curve sheath

“…When compared with manual‐guided navigation, RMN‐guided catheter ablation in AF offers the advantages of precise and flexible catheter navigation, reduction in peri‐procedure complications, and fluoroscopy exposure 11,12 . In this study, the total procedure time of all patients was shorter than that reported in our recent article, 13 which showed that procedure time decreased along the learning curve from 2010 to 2019. Moreover, all data in this study were derived with the third‐generation RMN system (Niobe ES), providing faster magnetic field direction changes than the Niobe II system, thus reducing procedure and RF times during AF ablation 14 .…”

Comparison of the Mid-Term Outcomes of Robotic Magnetic Navigation-Guided Radiofrequency Ablation versus Cryoballoon Ablation for Persistent Atrial Fibrillation

“…As described previously [ 10 ], the open-irrigated ablation catheter (NaviStar™ RMT ThermoCool™; Biosense Webster, CA, USA) was connected to a 3D mapping system (CARTO™, Biosense Webster, CA, USA or EnSite™, St. Jude Medical, MN, USA) and the RMN Niobe™ ES system (Stereotaxis Inc., St. Louis, MO, USA) to perform 3D LA electroanatomic mapping and ablation. Additional fracture potential ablation or linear ablation might be performed when necessary.…”