title: Remote-controlled magnetic pulmonary vein isolation using a new three-dimensional non-fluoroscopic navigation system: a single-centre prospective study.
abstract: BACKGROUND
  Catheter ablation of atrial fibrillation (AF) focuses on pulmonary vein isolation (PVI), but the procedure is associated with significant X-ray exposure. Few data exist concerning the combination of remote magnetic navigation (RMN) and a new three-dimensional non-fluoroscopic navigation system (Carto(®) 3), which facilitates precise catheter navigation and limits X-ray exposure.
  
  
  OBJECTIVE
  To assess the efficacy and extent of fluoroscopic exposure associated with the combination of RMN and the Carto 3 system in patients requiring AF ablation.
  
  
  METHODS
  Between January and September 2011, catheter ablation was performed remotely using the Carto 3 system in 81 consecutive patients who underwent PVI for symptomatic drug-refractory AF. The radiofrequency generator was set to a fixed power ≤ 35W. The primary endpoint was wide-area circumferential PVI confirmed by spiral catheter recording during ablation and including additional lesion lines (left atrial roof and coronary sinus defragmentation) or complex fractionated atrial electrograms for persistent AF. Secondary endpoints included procedural data, complications and freedom from atrial tachycardia (AT)/AF.
  
  
  RESULTS
  Mean age was 60 ± 9 years; 20% were women; 73% had symptomatic paroxysmal AF; 27% had persistent AF. The CHA2DS2-VASc score was 1.2 ± 1. Median procedure time was 3.5 ± 1 hours; median total X-ray exposure time was 13 ± 7 minutes; transseptal puncture and catheter positioning took 8 ± 4 minutes, left atrium electroanatomical reconstruction 1 ± 4 minutes and catheter ablation 3.5 ± 5minutes. Recurrences were AT (n=3; 3.7%), paroxysmal AF (n=8; 9.9%) and persistent AF (n=4; 4.9%); redo ablation was performed in these 15 (19%) patients. After a median follow-up of 15 ± 6 months and a single procedure, 71% of patients were free of symptoms; 84% remained asymptomatic after two procedures.
  
  
  CONCLUSIONS
  RMN with irrigated catheters combined with the Carto 3 system can be effectively performed in patients requiring AF ablation with minimal use of fluoroscopy, but larger randomized studies are warranted.
authors.affiliation: Service de Cardiologie, Hôpital Nord, CHU de Saint-Étienne, Université Jean-Monnet, 42055 Saint-Étienne Cedex 2, France. Electronic address: dakosta@aol.com.
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Mouna
authors.initials: M
authors.lastname: Ben H'dech
authors.forename: Cécile
authors.initials: C
authors.lastname: Romeyer-Bouchard
authors.forename: Laurence
authors.initials: L
authors.lastname: Bisch
authors.forename: Alexis
authors.initials: A
authors.lastname: Gate-Martinet
authors.forename: Marie
authors.initials: M
authors.lastname: Levallois
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003196:Computer Graphics; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D005602:France; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D012008:Recurrence; D012086:Reoperation; D012371:Robotics / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D013617:Tachycardia, Supraventricular / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: 3D; AF; AT; Atrial fibrillation; Fibrillation atriale; Pulmonary vein; RF; RMN; Rayons X; Remote magnetic navigation; Robot magnétique; Système de cartographie 3-D; VKA; Veine pulmonaire; X-ray; atrial fibrillation; atrial tachycardia; radiofrequency; remote magnetic navigation; three-dimensional; vitamin K antagonist