Clinical efficacy of remote magnetic navigation-guided catheter ablation of premature ventricular contractions
Singh G, Lahiri MK, Khan A, Schuger CD. Clinical efficacy of remote magnetic navigation-guided catheter ablation of premature ventricular contractions. J Interv Card Electrophysiol. 2018;51(1):S120-S121.
Background: Premature ventricular contraction (PVC) mapping and ablation requires precise and stable catheterpositioning. Remote magnetic navigation (RMN) is an underutilized tool for ablation of idiopathic PVC's. Objectives: To describe feasibility, acute success and procedural safety of RMNguided catheter ablation of PVC's. Methods: Twenty-two consecutive patients underwent PVC ablation by a single operator using Niobe ® magneticnavigation system (Stereotaxis, Inc) and CARTO 3/RMT catheter. Intracardiac echocardiography (ICE) was used during all cases and earliest pre-QRS unipolar (QS) and bipolar electrograms were sought for. Mapping in anterior coronary sinus veins was performed in majority of cases. Retrograde aortic approach was aided with left atrial multi purpose sheath and a Mullin17-1=s sheath was used for trans-septal approach. Ablation power varied from 25 to 50 W using irrigated catheter. Results: Twenty-seven foci were targeted in 22 patients (59% females) with a mean age 54 years and ejection fraction (EF) of 48%. Six (27%) patients had reduced EF prior to ablation. PVC's were mapped in RVOT, LVOT, aorto-mitral continuity (AMC), basal anterolateral LV wall, peri-mitral (M), aortic cusps and in the cardiac veins as shown in figure. Excellent catheter stability was achieved in all cases especially in papillary muscle locations. No complications were observed. Acute success was achieved in 95% cases which was maintained at 6 months of mean follow up. Conclusion: Mapping and ablation of idiopathic PVC foci is feasible, safe and effective using remote magnetic navigation with additional benefits of reduced fluoroscopy exposure along with reduced operator fatigue.