title: Magnetically guided irrigated gold-tip catheter ablation of persistent atrial fibrillation--techniques, procedural parameters and outcome.
abstract: OBJECTIVE
  Magnetically guided irrigated ablation has been introduced for atrial fibrillation (AF) ablation. However, data on ablation of persistent AF is scarce, and first-generation platinum-iridium catheters were burdened by char formation at the catheter tip. Furthermore, energy transmission of these catheters may be suboptimal. Irrigated gold-tip catheters have been introduced to overcome these problems.
  
  
  METHODS
  Antral pulmonary vein (PV) isolation (PVAI) was performed using a 5-mm irrigated gold-tip magnetic catheter (power setting, 48 °C maximum, 50 W, 15 s lesion duration; flow-rate, 30 mL/min). The catheter tip was guided by a uniform magnetic field and a motor drive. Left atrial maps were created using an impedance-based left atrial reconstruction and fused with a preprocedural CT or an intraprocedural rotational angiography-based scan.
  
  
  RESULTS
  Fifty-seven patients (42 male, 61.9 ± 8.8 years) underwent PVAI for symptomatic, drug-refractory persistent AF. PVAI was performed successfully in all patients confirmed by entrance block. Procedure time (skin-to-skin) was 214 ± 47 min (104-354 min). Fluoroscopy time was 31 ± 21 min. Ablation time was 4,153 ± 1,350 s. No char or thrombus formation was found at the catheter tip. One pericardial tamponade was observed. Freedom from atrial tachyarrhythmias could be achieved in 57.9 % of the patients included in a follow-up of 11.6 ± 4.2 month. There was a trend to a better outcome in patients without previous attempts of AF ablation (n = 48; 60.4 % vs. 44.4 %, p = 0.47).
  
  
  CONCLUSIONS
  Remote magnetic navigation for PVAI seems to be safe and feasible using an irrigated gold-tip catheter. Effectiveness of this novel technique can be confirmed by mid-term outcome.
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Muntean
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Johannes
authors.initials: J
authors.lastname: Heintze
authors.forename: Jürgen
authors.initials: J
authors.lastname: Vogt
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D003287:Contrast Media; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006046:Gold; D006801:Humans; D021621:Imaging, Three-Dimensional; D007479:Iopamidol / Q000031:analogs & derivatives; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C057937:iomeprol; D006046:Gold; D007479:Iopamidol