title: Initial experience with catheter ablation using remote magnetic navigation in adults with complex congenital heart disease and in small children.
abstract: BACKGROUND
  The improved outcomes and increased availability of surgery for congenital heart disease (CHD) over the last three decades have created a small but steadily increasing subset of patients with unique needs: children and adults with complex arrhythmias in the setting of structural cardiac abnormalities. Radiofrequency catheter ablation (RFCA) in these patients, and in small children with normal cardiac anatomy, is effective but challenging. An understanding of specific anatomical and electrophysiological characteristics of these patients and the technical challenges in addressing them are critical to the success of this therapy. Tools specifically designed for intracardiac diagnosis and therapy in anatomically complex and/or small hearts remain scarce.
  
  
  OBJECTIVE
  We report single-center results from an ongoing registry of all patients with congenital heart disease and all children with complex arrhythmias in which the Magnetic Navigation System (MNS) was used.
  
  
  RESULTS
  Included in this report are 12 patients with CHD in whom 17 tachyarrhythmias were treated, and 11 pediatric patients with normal cardiac anatomy who each had a single arrhythmia. The procedures' duration and the duration of fluoroscopy time as well as arrhythmia recurrence rates were comparable to those found in previous reports of procedures performed in adults with structurally normal hearts, and the incidence of complications was quite low.
  
  
  CONCLUSIONS
  In patients with complex congenital malformations, retrograde mapping of the pulmonary venous atrium was feasible, eliminating the need for puncture of the atrial septum, or surgically placed baffle in many cases. Moreover, the design of the catheter eliminated the need for multiple mapping and ablation catheters.
  
  
  CONCLUSIONS
  Our findings suggest that RFCA using the MNS for arrhythmias after surgery for congenital heart disease and in pediatric patients is safe and effective.
authors.affiliation: Department of Electrophysiology Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bruno
authors.initials: B
authors.lastname: Schwagten
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
authors.forename: Martin
authors.initials: M
authors.lastname: Witsenburg
authors.forename: Frederik
authors.initials: F
authors.lastname: Duplessis
authors.forename: Andrew
authors.initials: A
authors.lastname: Thornton
authors.forename: Yves
authors.initials: Y
authors.lastname: van Belle
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008280:Magnetics / Q000379:methods*; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome