Remote magnetic navigation compared to contemporary manual techniques for the catheter ablation of ventricular arrhythmias in structural heart disease

Richard G Bennett; Timothy Campbell; Ashish Sood; Ashwin Bhaskaran; Kasun De Silva; Lloyd Davis; Pierre Qian; Gopal Sivagangabalan; Mark J Cooper; Clara K Chow; Aravinda Thiagalingam; A Robert Denniss; Stuart P Thomas; Eddy Kizana; Saurabh Kumar

doi:10.1016/j.heliyon.2021.e08538

Remote magnetic navigation compared to contemporary manual techniques for the catheter ablation of ventricular arrhythmias in structural heart disease

Heliyon. 2021 Dec 6;7(12):e08538. doi: 10.1016/j.heliyon.2021.e08538. eCollection 2021 Dec.

Authors

Richard G Bennett^{1

2}, Timothy Campbell^{1

2}, Ashish Sood^{1

2}, Ashwin Bhaskaran¹, Kasun De Silva¹, Lloyd Davis¹, Pierre Qian¹, Gopal Sivagangabalan¹, Mark J Cooper¹, Clara K Chow^{1

2}, Aravinda Thiagalingam¹, A Robert Denniss¹, Stuart P Thomas^{1

2}, Eddy Kizana^{1

3}, Saurabh Kumar^{1

2}

Affiliations

¹ Department of Cardiology, Westmead Hospital, Sydney, Australia.
² Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia.
³ Westmead Institute of Medical Research, Westmead, Sydney, New South Wales, Australia.

Abstract

Background: There are limited data comparing remote magnetic navigation (RMN) to contemporary techniques of manual-guided ventricular arrhythmia (VA) catheter ablation.

Objectives: We compared acute and long-term outcomes of VA ablation guided by either RMN or contemporary manual techniques in patients with structural heart disease.

Methods: From 2010-2019, 192 consecutive patients, with ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM) underwent catheter ablation for sustained ventricular tachycardia (VT) or premature ventricular complexes (PVCs), using either RMN (n = 60) or manual (n = 132) guided techniques. Acute success and VA-free survival were compared.

Results: In ICM, acute procedural success was comparable between the 2 techniques (manual 43.5% vs. RMN 29%, P = 0.11), as was VA-free survival (manual 83% vs. RMN 74%, P = 0.88), and survival free from cardiac transplantation and all-cause mortality (manual 88% vs. RMN 87%, P = 0.47), both at 12-months after final ablation. In NICM, manual compared to RMN guided, had superior acute procedural success (manual 46% vs. RMN 19%, P = 0.003) and VA-free survival 12-months after final ablation (manual 79% vs. RMN 41%, P = 0.004), but comparable survival free from cardiac transplantation and all-cause mortality 12-months after final ablation (manual 95% vs. RMN 90%, P = 0.52). Procedural duration was shorter in both subgroups undergoing manual guided ablation, whereas fluoroscopy dose and complication rates were comparable.

Conclusion: RMN provides similar outcomes to manual ablation in patients with ICM. In NICM however, acute success, and long-term VA-free survival was better with manual ablation. Prospective, multi-centre randomised trials comparing contemporary manual and RMN systems for VA catheter ablation are needed.

Keywords: Catheter ablation; Remote magnetic navigation; Structural heart disease; Ventricular tachycardia.