title: Remote magnetic navigation for circumferential pulmonary vein ablation: single-catheter technique or additional use of a circular mapping catheter?
abstract: OBJECTIVE
  Remote magnetic navigation (RMN) is utilized for catheter guidance during pulmonary vein ablation (PVA). We aimed to determine whether the additional use of a circular mapping catheter (CMC) influences efficacy and outcome of RMN-guided PVA.
  
  
  METHODS
  A total of 80 consecutive subjects (65 % male, age 62 ± 9 years) underwent circumferential PVA with a 3D mapping system and an RMN-guided irrigated catheter. Procedural endpoint was complete PV isolation (PVI), total radiofrequency (RF) time >60 min, or procedure duration >5 h. PVI was defined as an entrance and/or exit block, diagnosed with a CMC within the PV ostium or by pacing via the roving RMN-guided catheter (single-catheter technique). Prolonged Holter monitoring after 3 and 6 months was used to detect atrial tachyarrhythmia (AT/AF) recurrences.
  
  
  RESULTS
  Complete PVI was achieved in 56 % (45/80) of all subjects (isolated PVs per patient, 3.1 ± 1.2; RF time, 56.3 ± 17.2 min; procedure duration, 3.8 ± 0.8 h). Prospective validation of the single-catheter technique for diagnosing PVI demonstrated high concordance (94 %) with blinded CMC results. CMC use in first-time PVA was associated with similar total RF and procedure times but higher PV isolation rate. Upon multivariate analysis, CMC use, female gender, left PV, smaller PV ostium and repeat PVA predicted PVI during RMN-guided ablation. Persistent AF and mitral regurgitation at baseline and the number of non-isolated PVs predicted AT/AF recurrence during follow-up.
  
  
  CONCLUSIONS
  Concomitant CMC use for first-time, RMN-guided PVA is associated with similar procedure duration but higher PV isolation rates as compared to a single-catheter approach. Since the number of isolated PVs predicts freedom from AT/AF, CMC utilization appears advisable for first-time, RMN-guided PVA.
authors.affiliation: Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany, dirkvollmann2000@aol.com.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vollmann
authors.forename: Lars
authors.initials: L
authors.lastname: Lüthje
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Samuel
authors.initials: S
authors.lastname: Sossalla
authors.forename: Jan
authors.initials: J
authors.lastname: Sohns
authors.forename: Christian
authors.initials: C
authors.lastname: Röver
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D011846:Radio Waves; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome