Remote Magnetic Navigation to Guide Endocardial and Epicardial Catheter Mapping of Scar-Related Ventricular Tachycardia

Abstract

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.

Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP‐VT Multicenter Trial

“…However, prospective trials are lacking. [13][14][15] This is the first multicenter, prospective, single arm, single procedure trial evaluating the efficacy and safety of RMN-guided ablation of post-myocardial infarction VT.…”

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

“…One of the advantages of this system is the peculiar flexibility of the catheter, which therefore can be magnetically guided and stably positioned in sites difficult for standard catheters, such as the coronary cusps and the right ventricular outflow tract [68,69] . Single center studies show that in VT patients, endocardial and epicardial mapping and ablation using this system is safe and feasible with minimal radiation exposure for the patient [70,71] . It has been recently reported that remote magnetic navigation may be more effective than manual ablation [72] .…”

Remote Navigation for Complex Arrhythmia

“…32,[45][46][47][48][49][50] Parallel to the growing evidence of conventional epicardial ablation for VT, the magnetic navigation system has been used in the epicardial space, which became possible when the irrigated catheter became available. 50,51 Results on safety and feasibility of the technology in diagnosing and treating complex ventricular arrhythmias were initially reported in 2007 50,52 in both animal models 52 and in humans, 50 with good overall results and minimal fluoroscopy exposure using a 4-mm solid-tip magnetic catheter. Dinov et al 53 retrospectively analysed the long-term efficacy of a single procedure ablation for ischaemic VT and compared it with manual radiofrequency ablation in 102 patients using irrigated-tip catheters.…”