Comparison of remote magnetic navigation ablation and manual ablation of idiopathic ventricular arrhythmia after failed manual ablation.
OBJECTIVE
Catheter ablation for idiopathic ventricular arrhythmia (VA) is effective and safe, but efficacy is frequently limited due to an epicardial origin and difficult anatomy. The remote magnetic navigation (RMN) catheter has a flexible catheter design allowing access to difficult anatomy. We describe the efficacy of the RMN for ablation of idiopathic VA after failed manual ablation.


METHODS
Among 235 patients with idiopathic VA referred for catheter ablation, we identified 51 patients who were referred for repeat ablation after a failed manual ablation. We analyzed the clinical characteristics, including the successful ablation site and findings at electrophysiology study, in repeat procedures conducted using RMN as compared with manual ablation. Among these patients, 22 (43 %) underwent repeat ablation with the RMN and 29 (57 %) underwent repeat ablation with a manual ablation.


RESULTS
Overall, successful ablation rate was significantly higher using RMN as compared with manual ablation (91 vs. 69 %, P = 0.02). Fluoroscopy time in the RMN was 17 ± 12 min as compared with 43 ± 18 min in the manual ablation (P = 0.009). Successful ablation rate in the posterior right ventricular outflow tract (RVOT) plus posterior-tricuspid annulus was higher with RMN as compared with manual ablation (92 vs. 50 %, P = 0.03). Neither groups exhibited any major complications.


CONCLUSIONS
The RMN is more effective in selected patients with recurrent idiopathic VA after failed manual ablation and is associated with less fluoroscopy time. The RMN catheters have a flexible design enabling them to access otherwise difficult anatomy including the posterior tricuspid annulus and posterior RVOT.
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA. kamitsu0709@yahoo.co.jp.
Mitsuharu
M
Kawamura
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
Melvin M
MM
Scheinman
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
Zian H
ZH
Tseng
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
Byron K
BK
Lee
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
Gregory M
GM
Marcus
The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
Nitish
N
Badhwar
D018780:Body Surface Potential Mapping / Q000379:methods / Q000706:statistics & numerical data; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008280:Magnetics / Q000379:methods; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome
Catheter ablation; Manual ablation; Remote magnetic navigation; Repeat procedure; Ventricular arrhythmia