title: Initial experience with remote magnetic navigation for left ventricular lead placement.
abstract: BACKGROUND
  A novel magnetic navigation system allows remote steering of guidewires and catheters. This system may be used for left ventricular lead placement for cardiac resynchronization therapy (CRT). We sought to evaluate the feasibility and safety of magnetic guidewire navigation for CRT procedures.
  
  
  METHODS
  123 consecutive patients underwent CRT implantation/revision procedures (including pacemaker upgrades in n=22 and left ventricular lead placement after dislocation in n=4 patients). Left ventricular lead placement in a coronary sinus side branch was performed either conventionally or using magnetic navigation. The magnetic navigation system (Niobe) consists of two permanent magnets creating a steerable magnetic field. Guidewires with integrated magnets align to the magnetic field and were used for over-the-wire implantation of pacemaker leads in the coronary sinus. Patients were assigned to conventional (n=93) or magnetic (n=30) navigation according to room availability. Venography of the coronary venous system was performed to select a target vessel for lead implantation.
  
  
  RESULTS
  Guidewire access to the target vessel was achieved in 100% using magnetic navigation compared to 87% with the conventional approach (P < 0.05). Implantation success rates, total procedure and fluoroscopy times did not differ significantly between groups. No periprocedural death and no intraoperative device dysfunction occurred in either group.The magnetic guidewire ruptured in one patient.
  
  
  CONCLUSIONS
  Left ventricular lead placement using magnetic guidewire navigation to engage the desired coronary sinus side branch can be successfully performed for CRT.
authors.affiliation: Department of Cardiology, Department of Cardiothoracic Surgery, RWTH Aachen University, Aachen, Germany. kmischke@ukaachen.de
authors.forename: Karl
authors.initials: K
authors.lastname: Mischke
authors.forename: Christian
authors.initials: C
authors.lastname: Knackstedt
authors.forename: Michael
authors.initials: M
authors.lastname: Schmid
authors.forename: Nima
authors.initials: N
authors.lastname: Hatam
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Jan
authors.initials: J
authors.lastname: Spillner
authors.forename: Kerstin
authors.initials: K
authors.lastname: Fache
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008280:Magnetics; D008297:Male; D010138:Pacemaker, Artificial; D010690:Phlebography