Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia.
BACKGROUND
Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation.


OBJECTIVE
The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation.


METHODS
Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible.


RESULTS
Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days).


CONCLUSIONS
RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.
Thornton
Andrew S
AS
Department of Clinical Electrophysiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands. a.thornton@erasmusmc.nl
Jordaens
Luc J
LJ
D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome