title: Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter.
abstract: BACKGROUND
  A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus-dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8-mm-tip magnetic catheter to perform RF ablation in patients with AFL.
  
  
  METHODS
  Twenty-six consecutive patients (23 men, mean age 64.6 +/- 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8-mm-tip magnetic catheter (70 degrees C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients.
  
  
  RESULTS
  The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and sinus rhythm in six patients. Due to technical issues, the ablation in the 18th patient could not be done with the MNS, and so we switched to conventional ablation. The remote magnetic navigation and ablation procedure was successful in 24 of the 25 (96%) remaining patients with AFL. In one patient (patient 2), conventional catheter was used to complete the isthmus block after termination of AFL. The procedure, preparation, ablation, and fluoroscopy times (median [range]) were 53 (30-130) minutes, 28 (10-65) minutes, 25 (12-78) minutes, and 7.5 (3.2-20.8) minutes, respectively. Patients in group 2 had shorter procedure (45 [30-70] min vs 80 [57-130] min, P = 0.0001), preparation (25 [10-30] min vs 42 [30-65] min, P = 0.0001), ablation (20 [12-40] min vs 31 [20-78] min, P = 0.002), and fluoroscopy (7.2 [3.2-12.2] min vs 11.0 [5.4-20.8] min, P = 0.014) times. No complication occurred during the procedure.
  
  
  CONCLUSIONS
  Using a remote MNS and an 8-mm-tip magnetic catheter, ablation of AFL is feasible, safe, and effective. Our data suggest that there is a short learning curve for this procedure.
authors.affiliation: Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany. dr.arasharya@gmail.com
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerdes-Li
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*