title: Remote-controlled magnetic navigation and ablation with 3D image integration as an alternative approach in patients with intra-atrial baffle anatomy.
abstract: BACKGROUND
  Improvement in outcome of infants born with congenital heart defects has been accompanied by an increasing frequency of late arrhythmias. Ablation is difficult because of multiple tachycardias in the presence of complex anatomy with limited accessibility. We report on remote-controlled ablation using magnetic navigation in conjunction with 3D image integration in patients with previous intra-atrial baffle procedures.
  
  
  RESULTS
  Thirteen patients (8 male; age, 30.5±8 years) with supraventricular tachycardia (SVT) underwent catheter ablation. Group A had a medical history of a Mustard or Senning operation, whereas group B had undergone total cavopulmonary connection. A total of 26 tachycardias were treated in 17 procedures (median cycle length of 280 ms). Group A patients had more inducible SVTs than group B, and all index SVTs were located in the remainder of the morphological right atrium in all but 1 patient. Retrograde access through the aorta was performed and led to successful ablation, using magnetic navigation with a very low total radiation exposure (median of 3.8 minutes in group A versus 5.9 minutes in group B). Only 1 of 13 patients continued to have short-lasting SVTs despite 3 ablation procedures during a median follow-up time of >200 days.
  
  
  CONCLUSIONS
  Remote-controlled catheter ablation by magnetic navigation in combination with accurate 3D image integration allowed safe and successful elimination of SVTs, using an exclusively retrograde approach, resulting in low radiation exposure for patients after intra-atrial baffle procedures (Mustard, Senning, or total cavopulmonary connection).
authors: Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom.
authors: Sabine
authors: S
authors: Ernst
authors: Sonya V
authors: SV
authors: Babu-Narayan
authors: Jennifer
authors: J
authors: Keegan
authors: Irina
authors: I
authors: Horduna
authors: Jonathan
authors: J
authors: Lyne
authors: Janice
authors: J
authors: Till
authors: Philip J
authors: PJ
authors: Kilner
authors: Dudley
authors: D
authors: Pennell
authors: Michael L
authors: ML
authors: Rigby
authors: Michael A
authors: MA
authors: Gatzoulis
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000294:innervation* / Q000473:pathology; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome