title: Remote magnetic navigation: human experience in pulmonary vein ablation.
abstract: 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.
authors: Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Luigi
authors: L
authors: Di Biase
authors: Tamer S
authors: TS
authors: Fahmy
authors: Dimpi
authors: D
authors: Patel
authors: Rong
authors: R
authors: Bai
authors: Kenneth
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authors: Civello
authors: Oussama M
authors: OM
authors: Wazni
authors: Mohamed
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authors: Kanj
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authors: CS
authors: Elayi
authors: Chi Keong
authors: CK
authors: Ching
authors: Mohamed
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authors: Khan
authors: Lucie
authors: L
authors: Popova
authors: Robert A
authors: RA
authors: Schweikert
authors: Jennifer E
authors: JE
authors: Cummings
authors: J David
authors: JD
authors: Burkhardt
authors: David O
authors: DO
authors: Martin
authors: Mandeep
authors: M
authors: Bhargava
authors: Thomas
authors: T
authors: Dresing
authors: Walid
authors: W
authors: Saliba
authors: Mauricio
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authors: Arruda
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authors: A
authors: Natale
mesh_terms: 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