title: Catheter ablation of right ventricular outflow tract tachycardia: a simplified remote-controlled approach.
abstract: OBJECTIVE
  Manual mapping and ablation of right ventricular outflow tract (RVOT) tachycardia may be associated with cardiac perforation and complicated by mechanically induced ventricular extrasystoles (VESs). The aim of this study was to assess remote-controlled magnetic (RCM) mapping and ablation of RVOT ventricular tachycardia (VT)/VES utilizing a soft magnetic catheter.
  
  
  RESULTS
  Mapping and ablation of RVOT VT/VES were performed using the magnetic navigation system (MNS, Niobe II, Stereotaxis, St Louis, MO) in conjunction with a cardiodrive motor unit (Stereotaxis). A soft magnetic catheter (Celsius RMT, 4 mm solid tip, Biosense Webster, Diamond Bar, CA) was navigated to the RVOT using a sequence of pre-installed magnetic vectors. The primary endpoint was defined as successful RCM VT/VES ablation. Other parameters observed included RCM RVOT accessibility, mapping-induced mechanical VES, fluoroscopy time, complications, and arrhythmia recurrence. Thirteen consecutive patients (mean age: 50 ± 14 years; 10 females, 6 RVOT VT) underwent RCM mapping and ablation. The RVOT was reached in all patients utilizing solely the MNS. Successful RCM RVOT ablation was achieved in {12 of 13} (92.3%) patients. Mean procedure and fluoroscopy times were 116.5 ± 48.9 and 7.5 ± 4.3 min, respectively. Catheter-induced VES during RVOT mapping were observed in {1 in 13} patients (7.7%, three VES). No complications occurred. During a mean follow-up of 252 ± 211 days, clinical arrhythmia recurrence was observed in {1 in 13} (7.7%) patients.
  
  
  CONCLUSIONS
  Automatic RCM RVOT access is feasible, while RVOT mapping and ablation appear to be safe, fast, and effective. The soft magnetic catheter rarely induces mechanical VES.
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstrasse 5, Hamburg, Germany. melkondoc@hotmail.com
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Buelent
authors.initials: B
authors.lastname: Koektuerk
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Zerm
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Julian K R
authors.initials: JK
authors.lastname: Chun
mesh_terms: D000328:Adult; D057791:Cardiac Imaging Techniques / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008280:Magnetics / Q000379:methods; D008297:Male; D008875:Middle Aged; D013610:Tachycardia / Q000175:diagnosis* / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000601:surgery*