Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: Results from a large single-center case-control series

Luigi Di Biase, Pasquale Santangeli, Vladimir Astudillo, Sergio Conti, Prasant Mohanty, Sanghamitra Mohanty, Javier E. Sanchez, Rodney Horton, Barbara Thomas, J. David Burkhardt, Andrea Natale

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. Objective: This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). Methods: A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. Results: Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 ± 1.2 hours vs. 3.3 ± 1.1 hours, P = 0.004) and RF time (24 ± 12 minutes vs. 33 ± 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 ± 22 minutes vs. 26 ± 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 ± 2.1 months of follow-up in the study group and 18.7 ± 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA. Conclusion: This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.

Original languageEnglish (US)
Pages (from-to)1029-1035
Number of pages7
JournalHeart Rhythm
Volume7
Issue number8
DOIs
StatePublished - 2010
Externally publishedYes

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Heart Ventricles
Cardiac Arrhythmias
Catheters
Catheter Ablation
Epicardial Mapping
Cardiomyopathies
Isoproterenol
Heart Diseases
Therapeutics

Keywords

  • Catheter ablation
  • Left ventricle
  • Magnetic robotic navigation
  • Pericardial space
  • Radiofrequency
  • Ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter : Results from a large single-center case-control series. / Di Biase, Luigi; Santangeli, Pasquale; Astudillo, Vladimir; Conti, Sergio; Mohanty, Prasant; Mohanty, Sanghamitra; Sanchez, Javier E.; Horton, Rodney; Thomas, Barbara; Burkhardt, J. David; Natale, Andrea.

In: Heart Rhythm, Vol. 7, No. 8, 2010, p. 1029-1035.

Research output: Contribution to journalArticle

Di Biase, Luigi ; Santangeli, Pasquale ; Astudillo, Vladimir ; Conti, Sergio ; Mohanty, Prasant ; Mohanty, Sanghamitra ; Sanchez, Javier E. ; Horton, Rodney ; Thomas, Barbara ; Burkhardt, J. David ; Natale, Andrea. / Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter : Results from a large single-center case-control series. In: Heart Rhythm. 2010 ; Vol. 7, No. 8. pp. 1029-1035.
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title = "Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: Results from a large single-center case-control series",
abstract = "Background: Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. Objective: This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). Methods: A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. Results: Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30{\%}), nonischemic in 14 (13{\%}), and in 63 (57{\%}) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33{\%}) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 ± 1.2 hours vs. 3.3 ± 1.1 hours, P = 0.004) and RF time (24 ± 12 minutes vs. 33 ± 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 ± 22 minutes vs. 26 ± 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14{\%}). At 11.7 ± 2.1 months of follow-up in the study group and 18.7 ± 3.7 months in the manual ablation group, 85{\%} and 86{\%} (P = 0.817) of patients, respectively, were free of VA. Conclusion: This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.",
keywords = "Catheter ablation, Left ventricle, Magnetic robotic navigation, Pericardial space, Radiofrequency, Ventricular arrhythmias",
author = "{Di Biase}, Luigi and Pasquale Santangeli and Vladimir Astudillo and Sergio Conti and Prasant Mohanty and Sanghamitra Mohanty and Sanchez, {Javier E.} and Rodney Horton and Barbara Thomas and Burkhardt, {J. David} and Andrea Natale",
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T1 - Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter

T2 - Results from a large single-center case-control series

AU - Di Biase, Luigi

AU - Santangeli, Pasquale

AU - Astudillo, Vladimir

AU - Conti, Sergio

AU - Mohanty, Prasant

AU - Mohanty, Sanghamitra

AU - Sanchez, Javier E.

AU - Horton, Rodney

AU - Thomas, Barbara

AU - Burkhardt, J. David

AU - Natale, Andrea

PY - 2010

Y1 - 2010

N2 - Background: Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. Objective: This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). Methods: A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. Results: Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 ± 1.2 hours vs. 3.3 ± 1.1 hours, P = 0.004) and RF time (24 ± 12 minutes vs. 33 ± 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 ± 22 minutes vs. 26 ± 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 ± 2.1 months of follow-up in the study group and 18.7 ± 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA. Conclusion: This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.

AB - Background: Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. Objective: This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). Methods: A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. Results: Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 ± 1.2 hours vs. 3.3 ± 1.1 hours, P = 0.004) and RF time (24 ± 12 minutes vs. 33 ± 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 ± 22 minutes vs. 26 ± 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 ± 2.1 months of follow-up in the study group and 18.7 ± 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA. Conclusion: This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.

KW - Catheter ablation

KW - Left ventricle

KW - Magnetic robotic navigation

KW - Pericardial space

KW - Radiofrequency

KW - Ventricular arrhythmias

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