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Catheter ablation is an accepted therapeutic alternative in symptomatic patients with atrial fibrillation (AF) resistant to anti-arrhythmic medications. Remote magnetic navigation (RMN) is one of the newer technologies for AF and has been used in ablation of supraventricular tachycardia and ventricular tachycardia. With this technology it is possible to magnetically direct the tip of a floppy catheter allowing the system to perform procedures that are difficult with manual catheter navigation (MCN).
Arya et al evaluated the acute and 6 month outcome of single catheter ablation procedure using RMN with an irrigated tip catheter in comparison to manual catheter navigation for ablation of paroxysmal and persistent AF.
In this retrospective case control study 356 patients with paroxysmal or persistent AF underwent catheter ablation using either RMN or MCN. A continuous 7-day-Holter ECG recording was done immediately after ablation and was repeated after 3 and 6 months. AF or atrial tachycardia longer than 30 sec was considered as an episode of recurrence.
RMN, compared with the control group, reduced the overall fluoroscopy time by 60% (34.5 vs. 13.7 min) and was associated with an increase in procedure and radiofrequency ablation times (223+/- 44 min vs. 166+/- 52 min). Moreover, complications appeared to be lower in the magnetic navigation group, but this was not statistically significant. The magnetic system has significantly lower maximal contact forces and thus may reduce complications like perforations. However complete pulmonary vein isolation was achieved in only 87.6% of patients in the RMN group compared to 99.6% in MCN group. (P<0.05). No difference was seen in AF recurrence between the two groups at 6 months.
In this single center, non-randomized study, remote navigation ablation appeared very safe and equally effective as manual navigation with lower radiation dose; although, this comes at the expense of longer procedure and ablation times. Randomized, controlled trials should be performed to further assess the safety and efficacy of the system.
1. Arya A, Zaker-Shahrak R, Sommer P, Bollmann A, Wetzel U, Gaspar T, Richter S, Husser D, Piorkowski C, Hindricks G.
Catheter ablation of atrial fibrillation using remote magnetic catheter navigation: a case-control study.
Europace. 2011 Jan;13(1):45-50.
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