title: Catheter ablation of scar-related ventricular tachycardia in patients with electrical storm using remote magnetic catheter navigation.
abstract: BACKGROUND
  A remote magnetic navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip catheter has not been evaluated in large series of patients.
  
  
  OBJECTIVE
  To evaluate acute and long-term efficiency of the newly available irrigated tip magnetic catheter for radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) in patients with ischemic heart disease.
  
  
  METHODS
  Between January 2008 and October 2009, a total of 30 consecutive patients with ischemic heart disease (26 men, age 70.1 ± 8.7 years, left ventricular ejection fraction: 30 ± 9%) and electrical storm due to monomorphic VT underwent RF ablation using a remote MNS and a magnetic irrigated tip catheter.
  
  
  RESULTS
  Acute success was defined as noninducibility of any monomorphic VT during programmed right and left ventricular stimulation, and obtained in 24 (80%) patients. A total of 1-6 VTs (mean 2.3 ± 1.2, 394 ± 108 ms, 210-660 ms) were inducible during each procedure. The duration of RF energy application was 41.2 ± 23.3 minutes, with total procedure and fluoroscopy times of 158 ± 47 minutes and 9.8 ± 5.3 minutes, respectively. No acute complications were observed during the procedures. During mean follow-up of 7.8 months, 21 patients (70%) had no recurrence of VT and received no implantable cardioverter defibrillator therapy. Among patients who were noninducible during programmed right ventricular stimulation (n = 25), ≥1 monomorphic VT was inducible during programmed left ventricular stimulation in four (16%) that was ablated successfully in three of them.
  
  
  CONCLUSIONS
  Irrigated ablation of scar-related VT using remote MNS is an effective modality for management of the monomorphic VT in patients with ischemic cardiomyopathy with minimal radiation exposure. Programmed left (in addition to right) ventricular stimulation might be necessary to assess acute outcome of the ablation procedure.
authors: Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany. dr.arasharya@gmail.com
authors: Arash
authors: A
authors: Arya
authors: Charlote
authors: C
authors: Eitel
authors: Andreas
authors: A
authors: Bollmann
authors: Ulrike
authors: U
authors: Wetzel
authors: Phillipp
authors: P
authors: Sommer
authors: Thomas
authors: T
authors: Gaspar
authors: Daniella
authors: D
authors: Husser
authors: Christopher
authors: C
authors: Piorkowski
authors: Gerhard
authors: G
authors: Hindricks
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002921:Cicatrix / Q000150:complications*; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D013318:Stroke Volume; D025321:Surgery, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome