title: Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: a randomized controlled study.
abstract: BACKGROUND
  No randomized controlled study has prospectively compared the performance and clinical outcomes of remote magnetic control (RMC) vs manual catheter control (MCC) during ablation of right ventricular outflow tract (RVOT) ventricular premature complexes (VPC) or ventricular tachycardia (VT).
  
  
  OBJECTIVE
  The purpose of this study was to prospectively evaluate the efficacy and safety of using either RMC vs MCC for mapping and ablation of RVOT VPC/VT.
  
  
  METHODS
  Thirty consecutive patients with idiopathic RVOT VPC/VT were referred for catheter ablation and randomized into either the RMC or MCC group. A noncontact mapping system was deployed in the RVOT to identify origins of VPC/VT. Conventional activation and pace-mapping was performed to guide ablation. If ablation performed using 1 mode of catheter control was acutely unsuccessful, the patient crossed over to the other group. The primary endpoints were patients' and physicians' fluoroscopic exposure and times.
  
  
  RESULTS
  Mean procedural times were similar between RMC and MCC groups. The fluoroscopic exposure and times for both patients and physicians were much lower in the RMC group than in the MCC group. Ablation was acutely successful in 14 of 15 patients in the MCC group and 10 of 15 in the RMC group. Following crossover, acute success was achieved in all patients. No major complications occurred in either group. During 22 months of follow-up, RVOT VPC recurred in 2 RMC patients.
  
  
  CONCLUSIONS
  RMC navigation significantly reduces patients' and physicians' fluoroscopic times by 50.5% and 68.6%, respectively, when used in conjunction with a noncontact mapping system to guide ablation of RVOT VPC/VT.
authors.affiliation: Section of Pacing and Electrophysiology, Division of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.forename: Hongwu
authors.initials: H
authors.lastname: Chen
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.forename: Pipin
authors.initials: P
authors.lastname: Kojodjojo
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D057785:Catheters; D005260:Female; D005471:Fluoroscopy; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000601:surgery*
keywords: BO; EA; Idiopathic ventricular arrhythmia; LBBB; MCC; MEA; MNS; Magnetic catheter; Magnetic navigation system; NCM; Noncontact mapping; RBBB; RMC; RVOT; Right ventricular outflow tract; VA; VPC; VT; breakout; earliest activation; left bundle branch block; magnetic navigation system; manual catheter control; multielectrode array; noncontact mapping system; remote magnetic control; right bundle branch block; right ventricular outflow tract; ventricular arrhythmia; ventricular premature complex; ventricular tachycardia