Remote Magnetic Navigation Versus Manually Controlled Catheter Ablation of Right Ventricular Outflow Tract Ventricular Arrhythmias: A Retrospective Two Center Experience

Ayelet Shauer1, Mohammed Shurrab1, Sheldon Singh1, Ilan Lashevsky1, Irving Tiong1, David Newman1, Lennart J. Devries2, Tamas Szili-Torok2, Eugene Crystal1
1 Schulich Heart Center, Sunnybrook Health Sciences Centre, Canada
2 Cardiology, Erasmus University Medical Center, Netherlands

Background: Remote magnetic navigation (RMN) has been introduced as an alternative to manual catheter control (MCC) radiofrequency ablation of right ventricular outflow tract (RVOT) arrhythmia. The comparative data to support RMN approach are limited.

Objective: The aim of this study was to retrospectively evaluate the clinical and procedural outcomes in a cohort of patients undergoing RVOT PVCs/VT ablation procedures using RMN vs. MCC.

Methods: One hundred eleven consecutive patients (mean age: 50, range 15-84 years, 64 males) who had RVOT PVCs/VT ablation were included (RMN: 49 patients vs MCC: 63 patients). Endocardial mapping using CARTOXPTM or CARTO3 (Biosense Webster) was used in 22/49 (45%) in RMN group and 36/63 (57%) in MCC group; EnSiteTM NavXTM (St. Jude Medical) system was used in the rest of the cohort. Stereotaxis platform (Stereotaxis Inc, St. Louis, MO) was used for RMN approach.

Results: The procedural time was 119±54 min in the RMN group and 118±69 min MCC (p=0.90). However, total fluoroscopic time was only 12±7 min in RMN vs. 23±14 in MCC group (p=0.000002). Total ablation energy application time was 8.4±7.0 min in RMN vs. 8.6±7.0 min in MCC, p=0.93). There were three minor complications in the RMN group and three major and three minor in the MCC group (p= 0.08 for major complications). Acute procedural success rate was 86% in RMN vs 76% in MCC group, (p=0.23). Long term success was available for 106 of the 111 patients. The success rate during mean follow up of 23.6 months was 68% in both groups (P=1.0)

Conclusions: RVOT arrhythmia ablation using Stereotaxis platform RMN demonstrates lower fluoroscopic time with no higher complication rate than ablation with manual approach. Acute and long term success rate are not significantly different.