Remote magnetic versus manual catheters: evaluation of ablation effect in atrial fibrillation by myocardial marker levels

Abstract

BackgroundA remote magnetic navigation (MN) system is available for radiofrequency ablation of atrial fibrillation (AF), challenging the conventional manual ablation technique. The myocardial markers were measured to compare the effects of the two types of MN catheters with those of a manual-irrigated catheter in AF ablation.MethodsAF patients underwent an ablation procedure using either a conventional manual-irrigated catheter (CIR, n = 65) or an MN system utilizing either an irrigated (RMI, n = 23) or non-irrigated catheter (RMN, n = 26). Levels of troponin T (TnT) and the cardiac isoform of creatin kinase (CKMB) were measured before and after ablation.ResultsMean procedure times and total ablation times were longer employing the remote magnetic system. In all groups, there were pronounced increases in markers of myocardial injury after ablation, demonstrating a significant correlation between total ablation time and post-ablation levels of TnT and CKMB (CIR r = 0.61 and 0.53, p < 0.001; RMI r = 0.74 and 0.73, p < 0.001; and RMN r = 0.51 and 0.59, p < 0.01). Time-corrected release of TnT was significantly higher in the CIR group than in the other groups. Of the patients, 59.6% were free from AF at follow-up (12.2 ± 5.4 months) and there were no differences in success rate between the three groups.ConclusionsRemote magnetic catheters may create more discrete and predictable ablation lesions measured by myocardial enzymes and may require longer total ablation time to reach the procedural endpoints. Remote magnetic non-irrigated catheters do not appear to be inferior to magnetic irrigated catheters in terms of myocardial enzyme release and clinical outcome.

Impact of catheter ablation with remote magnetic navigation on procedural outcomes in patients with persistent and long-standing persistent atrial fibrillation

“…This is much lower than the 4.5 % major complication rate from an updated worldwide survey of catheter ablation for AF [15]. The result is consistent with other studies about the excellent safety record of the atraumatic flexible catheter employed with RMN [16][17][18]. Also, a relatively reduced procedure time in our study is another cause to reduce the incidence of complications.…”

Safety and Long‐Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity‐Score Analysis

“…Finally, our findings corroborate other studies showing that MNS ablations take longer to perform but expose patients to less fluoroscopy time . Since the radiofrequency power was similar by protocol in both groups, the lower contact force in the MNS might be responsible for a longer time to achieve pulmonary vein isolation.…”

“…To the best of our knowledge, this is the largest and longest follow‐up comparison between MNS and manually navigated AF ablation. Several studies have addressed this subject, but these have generally been limited by non‐randomized design, small sample sizes, and relatively short follow‐up periods . The available evidence gathered in 2 recent systematic reviews and meta‐analyses suggests that both techniques have similar relapse rates, a notion that is strengthened by our study …”

Remote magnetic navigation versus manual catheter ablation of atrial fibrillation: A single center long‐term comparison

“…Later, in accordance with the release of new guidelines, RFCA was also considered as first line therapy for patients with recurrent symptomatic AF in our center. Success rates of remote magnetic catheter navigation (RMN) ablation were reported to be non-inferior to manual catheter navigation (MCN) [4][5][6][7][8][9][10][11][12][13][14][15][16][17] including initial prospective results from our center. 17 However, most of the previous studies consisted only of small patient numbers and a followup of less than 12 months.…”