title: Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: results from a large single-center case-control series.
abstract: BACKGROUND
  Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips.
  
  
  OBJECTIVE
  This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC).
  
  
  METHODS
  A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator.
  
  
  RESULTS
  Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 +/- 1.2 hours vs. 3.3 +/- 1.1 hours, P = 0.004) and RF time (24 +/- 12 minutes vs. 33 +/- 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 +/- 22 minutes vs. 26 +/- 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 +/- 2.1 months of follow-up in the study group and 18.7 +/- 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA.
  
  
  CONCLUSIONS
  This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.
authors.affiliation: Texas Cardiac Arrhythmia Institute at St. David Medical Center, Austin, Texas, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Vladimir
authors.initials: V
authors.lastname: Astudillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Conti
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: Barbara
authors.initials: B
authors.lastname: Thomas
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac; D056149:Epicardial Mapping; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome