Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation

Abstract

BackgroundOnly limited data exist on the clinical utility of remote magnetic navigation (RMN) for pulmonary vein (PV) ablation. Aim of this prospective study was to evaluate the safety and efficacy of RMN for PV isolation as compared to the manual (CON) approach.Methods and resultsA total of 161 consecutive patients undergoing circumferential PV isolation were included. Open-irrigated 3.5 mm ablation catheters under the guidance of a mapping system were used. The catheter was navigated with the Stereotaxis Niobe II system in the RMN group (n = 107) and guided manually in the CON group (n = 54). Electrical isolation of all PVs was achieved in 90% of the patients in the RMN group and in 87% in the CON group (p = 0.6). All subjects were followed every 3 months by 7d Holter-ECG. At 12 months of follow-up, 53.5% (RMN) and 55.5% (CON) of the patients were free of any left atrial tachycardia/atrial fibrillation (AF) episode (p = 0.57). Free of symptomatic AF recurrence were 66.3% (RMN) and 62.1% (CON) of the subjects (p = 0.80). Use of RMN was associated with longer procedure duration (p < 0.0001), ablation times (p < 0.0001), and RF current application duration (p < 0.05). In contrast, fluoroscopy time was lower in the RMN group (p < 0.0001). Major complications occurred in 6 of 161 procedures (3.7%), with no significant difference between groups (p = 0.75).ConclusionRMN-guided PV ablation provides comparable acute and long-term success rates as compared to manual navigation. Procedural complication rates are similar. The use of RMN is associated with markedly reduced fluoroscopy time, but prolonged ablation and procedure duration.

The Future of Pulmonary Vein Isolation – Single-shot Devices, Remote Navigation or Improving Conventional Radiofrequency Delivery by Contact Monitoring and Lesion Characterisation?

“…56 Further introduction of magnetic irrigated-tip catheters and larger series confirmed high rates of acute isolation of all PV (≈90 %) and similar rates of patients remaining free from AF after midterm follow-up (6-18 months) compared with conventional manual RF approach (≈70 %). 58,59 Ablation times were longer in the magnetic navigation group compared with the manual approach. The latter could be explained by less effective linear lesions using remote magnetic ablation due to lower maximal endocardial force exerted by the remote magnetic navigation system to the magnetic catheter tip compared with manually-applied force to the conventional ablation catheter tip.…”

Remote Navigation for Complex Arrhythmia

“…33 However, an 8-mm ablation catheter was the only alternative available to the 4-mm tip catheter used in SVT ablations; it was to no surprise that remote ablation was possible, but ran the known higher risk of clot formation at the tip (as compared with irrigated-tip catheters). 34 Although the initially reported results in AF ablation using the RMN system and solid-tip magnetic catheter varied significantly among groups [33][34][35][36][37][38][39][40][41] (see Table 1); more recent data using irrigated-tip magnetically navigated catheters showed more promising results with increased safety profile. The introduction of a magnetic catheter with an irrigated-tip allowed avoidance of the thromboembolic risk and several groups have published their results, which are comparable to conventional technologies.…”

“…The introduction of a magnetic catheter with an irrigated-tip allowed avoidance of the thromboembolic risk and several groups have published their results, which are comparable to conventional technologies. [35][36][37][38][39][40][41] Two centres have jointly published their experience in a total of 71 patients with either paroxysmal or persistent AF. They reported safe and effective remote-controlled manipulation for reconstruction of the left atrium (LA) and mapping of the pulmonary veins (PVs).…”

Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation: Experience from 1,006 Procedures

“…16 In this study as well as two other cited studies, a single RMNcatheter approach for AF ablation achieved comparable midterm success rates when compared with manual ablation. 2,9 A total of 76.5% and 60% patients were free from recurrence at 9-month follow-up in PAF and PerAF groups, respectively. Also, 32% PAF and 34% PerAF patients underwent repeat ablations after about one year and six months postinitial ablation.…”

“…Pacing, at multiple points while moving the RMN catheter tip in a circular fashion within the PV, was performed to check for exit block. 2,9 Complete electrical isolation was verified by repeated mapping for residual potentials around the entire circumference of the PV ostia during sinus rhythm (SR). A circular multipolar catheter was not used to asses for PV conduction/isolation.…”