Remote magnetic navigation: human experience in pulmonary vein ablation.
OBJECTIVE
We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF).


BACKGROUND
This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill.


METHODS
After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs).


RESULTS
Using the coordinate approach, the target location was reached in only 60% of the sites, whereas by using the wand approach 100% of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8%) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33%) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 +/- 2 months, recurrence was seen in 5 patients (22%) with complete PVAI and in 20 patients (90%) with incomplete PVAI.


CONCLUSIONS
Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.
Di Biase
Luigi
L
Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Fahmy
Tamer S
TS
Patel
Dimpi
D
Bai
Rong
R
Civello
Kenneth
K
Wazni
Oussama M
OM
Kanj
Mohamed
M
Elayi
Claude S
CS
Ching
Chi Keong
CK
Khan
Mohamed
M
Popova
Lucie
L
Schweikert
Robert A
RA
Cummings
Jennifer E
JE
Burkhardt
J David
JD
Martin
David O
DO
Bhargava
Mandeep
M
Dresing
Thomas
T
Saliba
Walid
W
Arruda
Mauricio
M
Natale
Andrea
A
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002404:Catheterization; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012371:Robotics