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.
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.
Di Biase
Luigi
L
Texas Cardiac Arrhythmia Institute at St. David Medical Center, Austin, Texas, USA.
Santangeli
Pasquale
P
Astudillo
Vladimir
V
Conti
Sergio
S
Mohanty
Prasant
P
Mohanty
Sanghamitra
S
Sanchez
Javier E
JE
Horton
Rodney
R
Thomas
Barbara
B
Burkhardt
J David
JD
Natale
Andrea
A
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