Remote-controlled magnetic pulmonary vein isolation using a new irrigated-tip catheter in patients with atrial fibrillation.
BACKGROUND
Lack of an irrigated-tip magnetic catheter has limited the role of remote-controlled magnetic navigation (Niobe II, Stereotaxis) for catheter ablation of atrial fibrillation (AF).


RESULTS
A novel 3.5-mm-tip irrigated magnetic catheter (group 1, Thermocool Navistar RMT, Biosense Webster) was used for 3D left atrial reconstruction (CARTO RMT) and remote-controlled magnetic pulmonary vein isolation. A redesigned catheter was used in group 2. The primary end point was wide area circumferential pulmonary vein isolation confirmed by spiral catheter recording during ablation; secondary end points included procedural data, complications, and AF recurrence. Fifty-six consecutive patients [group 1: 28 patients, 22 males, age 64 (38 to 78) years, left atrium: 47 (34 to 52) mm; paroxysmal AF: n=21, persistent AF: n=7; group 2: 28 patients, 20 males, age 60 (24 to 78) years, left atrium: 40 (35 to 53) mm; paroxysmal AF: n=18, persistent AF: n=10] were included. The primary end point was achieved in a total of 52 of 56 (93%) patients. Median procedure duration was 315 (125 to 550) minutes (group 1: 370 [230 to 550] minutes; group 2: 243 [125 to 450] minutes). Median fluoroscopy exposure to the investigator was reduced by 31%. Tip charring in 17 of 28 (61%) and complications in 3 of 28 (11%) patients in group 1 resulted in a catheter redesign. Sinus rhythm was maintained by 35 of 50 (70%) patients during a median follow-up period of 545 (100 to 683) days.


CONCLUSIONS
Remote-controlled magnetic AF ablation with real-time verification of pulmonary vein isolation is feasible with a comparable success rate to manual ablation. Safety improved after a redesign of the catheter.
Chun
K R Julian
KR
Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany. jongichun@t-online.de
Wissner
Erik
E
Koektuerk
Buelent
B
Konstantinidou
Melanie
M
Schmidt
Boris
B
Zerm
Thomas
T
Metzner
Andreas
A
Tilz
Roland
R
Boczor
Sigrid
S
Fuernkranz
Alexander
A
Ouyang
Feifan
F
Kuck
Karl-Heinz
KH
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000295:instrumentation*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008280:Magnetics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D013686:Telemetry / Q000379:methods*; D007507:Therapeutic Irrigation / Q000295:instrumentation; D016896:Treatment Outcome