Remote magnetic navigation compared to contemporary manual techniques for the catheter ablation of ventricular arrhythmias in structural heart disease.

Abstract

BACKGROUND:

There are limited data comparing remote magnetic navigation (RMN) to contemporary techniques of manual-guided ventricular arrhythmia (VA) catheter ablation.

OBJECTIVES:

We compared acute and long-term outcomes of VA ablation guided by either RMN or contemporary manual techniques in patients with structural heart disease.

METHODS:

From 2010-2019, 192 consecutive patients, with ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM) underwent catheter ablation for sustained ventricular tachycardia (VT) or premature ventricular complexes (PVCs), using either RMN (n = 60) or manual (n = 132) guided techniques. Acute success and VA-free survival were compared.

RESULTS:

In ICM, acute procedural success was comparable between the 2 techniques (manual 43.5% vs. RMN 29%, P = 0.11), as was VA-free survival (manual 83% vs. RMN 74%, P = 0.88), and survival free from cardiac transplantation and all-cause mortality (manual 88% vs. RMN 87%, P = 0.47), both at 12-months after final ablation. In NICM, manual compared to RMN guided, had superior acute procedural success (manual 46% vs. RMN 19%, P = 0.003) and VA-free survival 12-months after final ablation (manual 79% vs. RMN 41%, P = 0.004), but comparable survival free from cardiac transplantation and all-cause mortality 12-months after final ablation (manual 95% vs. RMN 90%, P = 0.52). Procedural duration was shorter in both subgroups undergoing manual guided ablation, whereas fluoroscopy dose and complication rates were comparable.

CONCLUSION:

RMN provides similar outcomes to manual ablation in patients with ICM. In NICM however, acute success, and long-term VA-free survival was better with manual ablation. Prospective, multi-centre randomised trials comparing contemporary manual and RMN systems for VA catheter ablation are needed.

• Authors: Richard G Bennett, Timothy Campbell, Ashish Sood, Ashwin Bhaskaran, Kasun De Silva, Lloyd Davis, Pierre Qian, Gopal Sivagangabalan, Mark J Cooper, Clara K Chow, Aravinda Thiagalingam, A Robert Denniss, Stuart P Thomas, Eddy Kizana, Saurabh Kumar
• Journal: Heliyon (Heliyon) Vol. 7 Issue 12 Pg. e08538 (Dec 2021) ISSN: 2405-8440 [Print] England
• PMID: 34917813 (Publication Type: Journal Article)
• Copyright: Crown Copyright © 2021 Published by Elsevier Ltd.