A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation

Safety and Cost-Effectiveness of the FAM-DX Three-Dimensional CARTO Navigation System in Zero Fluoroscopy Electrophysiology Studies for Supraventricular Tachycardia: A Retrospective Cohort Study

Background The zero fluoroscopy (ZF) ablation technique reduces radiation exposure for both medical staff and patients but typically requires specialized navigation ablation catheters. The innovative FAM-DX Three-Dimensional CARTO Navigation System enables 3D mapping without the need for these specialized catheters. This study investigates the safety, feasibility, efficacy, and cost-effectiveness of using the FAM-DX system for ZF electrophysiology (EP) studies in patients with supraventricular tachycardia (SVT). Methods A retrospective analysis was performed at a single center on patients who underwent EP studies using the FAM-DX system between November 2021 and December 2023. Exclusion criteria included patients under 18, pregnant women, those with recent pacemaker implantation, and individuals requiring specific ablations. Clinical data, including patient characteristics, indications, procedure details, fluoroscopy use, ablation requirements, and any procedure-related adverse events, were collected. Results A total of 87 consecutive patients (mean age: 53 ± 18.9 years) were included in this retrospective cohort analysis. Of these, 86 patients (98.85%) successfully underwent ZF ablation using the FAM-DX 3D navigation system, with mapping conducted in various heart regions, including the right atrium, His bundle, coronary sinus, superior vena cava, and inferior vena cava. Only one patient required fluoroscopy due to vascular access issues. Notably, in 41% of cases (36 patients), the ablation catheter was not initially needed or used during the electrophysiological study, suggesting a potential cost-saving benefit given the catheter's cost of approximately $2,431. Conclusions Our study demonstrates that the FAM-DX system enables safe and efficient 3D mapping and ZF techniques for SVT EP studies. This cost-effective approach suggests that the use of ablation catheters may be unnecessary for certain patients. Further research is required to validate the broader adoption of ZF techniques and their application in more complex left-sided procedures.

Single catheter ablation of atrioventricular node in a patient with dextrocardia and permanent atrial fibrillation via peripheral vascular access using remote magnetic navigation: a case report

Background

Cardiac interventions may be challenging in patients with congenital cardiac abnormalities. This case reports cardiac resynchronization therapy pacemaker (CRT-P) implantation and single catheter ablation of atrioventricular node (AVN) with remote magnetic navigation (RMN) via peripheral vascular access in a patient with Kartagener's syndrome and permanent atrial fibrillation (AF).

Case summary

A 74-year-old male with situs inversus presented for treatment of permanent AF and severe heart failure. In echocardiography, left ventricular ejection fraction was 30%, and there was severe dyskinesia due to a left bundle branch block. After successful CRT-P implantation, we performed AVN ablation because biventricular (BiV) pacing was <75% despite maximal rate control medication. The ablation catheter was inserted from the right basilic vein, and no other catheters were used. Despite peripheral vascular access, manipulation of the ablation catheter with RMN was easy, and the ablation was successful. After the ablation, BiV pacing instantly increased to 100%, and left ventricular function and symptomatic status improved gradually.

Conclusions

Cardiac resynchronization therapy pacemaker implantation and RMN-guided single catheter ablation of the AVN in a patient with dextrocardia via peripheral vascular access was effective and safe. The use of RMN and peripheral vascular access may offer important advantages also in other patient groups.

Best practices in robotic magnetic navigation-guided catheter ablation of cardiac arrhythmias, a position paper of the Society for Cardiac Robotic Navigation

Preamble

Robotic magnetic navigation (RMN)-guided catheter ablation (CA) technology has been used for the treatment of cardiac arrhythmias for almost 20 years. Various studies reported that RMN allows for high catheter stability, improved lesion formation and a superior safety profile. So far, no guidelines or recommendations on RMN-guided CA have been published.

Purpose

The aim of this consensus paper was to summarize knowledge and provide recommendations on management of arrhythmias using RMN-guided CA as treatment of atrial fibrillation (AF) and ventricular arrhythmias (VA).

Methodology

An expert writing group, performed a detailed review of available literature, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Recommendations on RMN-guided CA are presented in a guideline format with three levels of recommendations to serve as a reference for best practices in RMN procedures. Each recommendation is accompanied by supportive text and references. The various sections cover the practical spectrum from system and patient set-up, EP laboratory staffing, combination of RMN with fluoroscopy and mapping systems, use of automation features and ablation settings and targets, for different cardiac arrhythmias.

Conclusion

This manuscript, presenting the combined experience of expert robotic users and knowledge from the available literature, offers a unique resource for providers interested in the use of RMN in the treatment of cardiac arrhythmias.

Overcoming Access Challenges to Treat Arrhythmias in Patients with Congenital Heart Disease Using Robotic Magnetic-Guided Catheter Ablation

The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly impact quality of life, hospitalizations, and mortality. Catheter ablation has gained widespread acceptance as a critical intervention for managing arrhythmias in patients with CHD. However, anatomical and physiological features unique to this population pose challenges to standard manual ablation procedures, potentially impacting safety and efficacy. Robotic magnetic-guided navigation (RMN) has emerged as a technological solution to address these challenges. By utilizing soft and flexible catheters equipped with magnets at their tips, RMN enables robotic steering and orientation of catheters in three-dimensional space. This technology overcomes obstacles such as distorted vascular pathways and complex post-surgical reconstructions to facilitate access to target chambers and improve maneuverability within the heart. In this review, we present an overview of the safety and efficacy evidence for RMN-guided catheter ablation in CHD patients and highlight potential advantages. Additionally, we provide a detailed case presentation illustrating the practical application of RMN technology in this population. Although the literature on RMN-guided ablation in patients with CHD remains limited, it has shown promise in achieving successful outcomes, particularly in cases where manual ablation failed or was deemed non-feasible. Further validation through large-scale prospective studies is necessary to fully ascertain the benefits of RMN technology in this patient population.

The performance of dipole charge density mapping integrated with robotic magnetic navigation in the treatment of atrial tachycardias

BACKGROUND

Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure.

METHODS

All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups.

RESULTS

A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21).

CONCLUSIONS

AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.

Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis

BACKGROUND

Robotic magnetic navigation (RMN) has emerged as a potential solution to overcome challenges associated with catheter ablation of arrhythmias in patients with congenital heart disease (CHD).

OBJECTIVES

To assess safety and efficacy of RMNguided catheter ablation in patients with CHD.

DESIGN AND METHODS

A systematic review and pooled analysis was conducted on patients with CHD who underwent RMNguided catheter ablation. Random effects models were used to generate pooled estimates with the inverse variance method used for weighting studies.

RESULTS

Twentyfour nonoverlapping records included 167 patients with CHD, mean age 36.5 years, 44.6% female. Type of CHD was simple in 27 (16.2%), moderate in 32 (19.2%), and complex in 106 (63.5%). A total of 202 procedures targeted 260 arrhythmias, the most common being macroreentrant atrial circuits. The mean procedural duration was 207.5 minutes, with a mean fluoroscopy time of 12.1 minutes. The pooled acute success rate was 89.2% [95% CI (77.8%, 97.4%)]. Freedom from arrhythmia recurrence was 84.5% [95% CI (72.5%, 94.0%)] over a mean follow-up of 24.3 months. The procedural complication rate was 3.5% with no complication attributable to RMN technology.

CONCLUSION

RMN-guided ablation appears to be safe and effective across a variety of arrhythmia substrates and types of CHD.

Dipole charge density mapping integrated in remote magnetic navigation: First-in-human feasibility study

Aims

Robotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures.

Material and methods

In this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared.

Results

AcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p < 0.01; 181.0 vs. 131.0 mGy, p = 0.02, respectively). Procedure duration and fluoroscopy use decreased significantly between the first 30 and the last 30 AcQMap-RMN procedures. The AcQMap-RMN system had fewer recurrences after persistent AF ablations and was non-inferior in paroxysmal AF patients compared to CARTO-RMN at 12 months (36.6% vs. 75.0%, p = 0.04, PAF 6.6% vs. 12.5%, p = 0.58; respectively). CA of AT outcomes were better using the AcQMap-RMN system (1 year recurrence 17.1% vs. 38.7%, p < 0.05).

Conclusion

AcQMap-RMN integration has no negative impact on the excellent safety profile of RMN guided ablations. It improves outcomes of CA procedures for persAF and AT but requires longer procedure times and higher fluoroscopy use during the initial learning phase.

Robotics for neuroendovascular intervention: Background and primer

The simultaneous growth of robotic-assisted surgery and telemedicine in recent years has only been accelerated by the recent coronavirus disease 2019 pandemic. Robotic assistance for neurovascular intervention has garnered significant interest due to opportunities for tele-stroke models of care for remote underserved areas. Lessons learned from medical robots in interventional cardiology and neurosurgery have contributed to incremental but vital advances in medical robotics despite important limitations. In this article, we discuss robot types and their clinical justification and ethics, as well as a general overview on available robots in thoracic/abdominal surgery, neurosurgery, and cardiac electrophysiology. We conclude with current clinical research in neuroendovascular intervention and a perspective on future directions.

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

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.

Long-Term Efficacy and Impact on Mortality of Remote Magnetic Navigation Guided Catheter Ablation of Ventricular Arrhythmias

Remote magnetic navigation (RMN) facilitates ventricular arrhythmia (VA) ablation. This study aimed to evaluate the long-term efficacy of RMN-guided ablation for ventricular tachycardia (VT) and premature ventricular contractions (PVC). A total of 176 consecutive patients (mean age 53.23 ± 17.55 years, 37% female) underwent VA ablation for PVC (132 patients, 75%) or VT (44 patients, 25%). The cohort consisted of 119 patients (68%) with idiopathic VA, 31 (18%) with ischemic (ICM), and 26 (15%) with dilated cardiomyopathy (DCM). VA recurrence was observed in 69 patients (39%, mean age 51.71 ± 19.91 years, 23% female) during a follow-up period of 5.48 years (first quartile 770.50 days, second quartile 1101.50 days, third quartile 1615.50 days). Left ventricular ejection fraction <40% lead to a significantly increased risk for VA (p = 0.031*). Multivariate analyses found DCM to be an independent predictor (IP) for VA recurrence (p < 0.001*, hazard ratio (HR) 3.74, confidence interval (CI) 1.58-8.88). ICM resulted in a lower increase in VA recurrence (p = 0.221, HR 1.49, CI 0.79-2.81). Class I/III/IV antiarrhythmic drug therapy (AADs) was also identified as IP for recurrence (p = 0.030*, HR 2.48, CI 1.11-5.68). A total of 16 patients (9%) died within the observational period. RMN-guided ablation of VA lead to acceptable long-term results. An impaired LV function, DCM, and AADs were associated with a significant risk for VA recurrence. Personalized paths are needed to improve efficacy and outcome.

Outcomes of manual versus remote magnetic navigation for catheter ablation of ventricular tachycardia: a systematic review and updated meta-analysis

PURPOSE

Ventricular tachycardia (VT) ablation is a complex procedure that requires remarkable catheter manipulation skill, great mapping accuracy and catheter stability, and can expose patients to serious complications. Magnetic navigation system (RMN)-guided ablation and contact force-sensing (CFS) catheters have the potential to overcome these obstacles. We performed a systematic review and updated meta-analysis of all available studies evaluating the outcomes of VT ablation by using RMN-guided compared to manual navigation (MAN)-guided, with and without CFS catheters.

METHODS

MEDLINE/PubMed, Cochrane, and Google Scholar were searched for randomized controlled trials (RCT) or observational studies with multivariate adjustment comparing RMN-guided versus MAN-guided VT ablation.

RESULTS

Thirteen studies enrolling 1348 patients (656 RMN-guided vs. 692 MAN-guided) were included. CFS catheter were used in 14% of MAN-guided patients. In comparison to MAN-guided and CFS-guided, RMN-guided VT ablation was associated with a significant higher acute ablation success (OR 2.32, 1.66-3.23 and OR 2.91, 1.29-6.53, respectively) but similar results in term of long-term VT recurrence (OR 0.75, 0.56-1.01 and OR 0.79, 0.27-2.36, respectively). RMN-guided showed a better safety profile (for all complications, OR 0.52, 0.34-0.81) and allowed a significant x-ray reduction compared to MAN-guided (OR 0.21, 0.14-0.32) and CFS-guided VT ablation (OR 0.23, 0.11-0.52, all 95% CI).

CONCLUSIONS

RMN-guided was superior to MAN-guided and CFS-guided VT ablation in term of acute ablation success, all complications endpoint, and reduction of fluoroscopy exposure, but did not reduce long-term VT recurrence. Large prospective multicenter randomized trials are needed to confirm these findings.

Meta-analysis comparing outcomes of catheter ablation for ventricular arrhythmia in ischemic versus nonischemic cardiomyopathy

Background

Catheter ablation is an effective treatment for ventricular arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in non‐ICM (NICM) patients are not satisfactory, and studies comparing differences between NICM and ICM are limited. We conducted a meta‐analysis of procedural characteristics and long‐term outcomes of catheter ablation for VA, comparing results between ICM and NICM.

Methods

Studies in the PubMed, EMBASE, and Cochrane databases were systematically reviewed. Four studies reporting comparison of catheter ablation of VA between ICM and NICM were examined. The Newcastle‐Ottawa Scale was used to appraise study quality. A random‐effects model with inverse variance method was used for comparisons.

Results

Epicardial approach was significantly more undertaken for the NICM group than in the ICM group (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09‐0.18; P < .00001). Mean ablation time (P = .54), fluoroscopy time (P = .55), and procedural time (P = .18) did not differ significantly between the ICM and NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24‐0.89; P = .02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46‐1.01; P = .06) were significantly higher in the NICM group than in the ICM group. However, all‐cause mortality (RR: 1.37; 95% CI: 0.75‐2.49; P = .31) did not differ significantly between groups.

Conclusions

Procedural failure and VA recurrence rates were significantly higher in the NICM group, despite significantly more frequent epicardial access. These highlight the limitations of catheter ablation for VA in NICM, given our current knowledge.

Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large-scale single-center study

Background

Remote magnetic navigation (RMN)‐guided ablation has become an inspiring method of catheter ablation for tachyarrhythmias.

Hypothesis

Data from a large‐scale single center may provide further insight into the safety of and the learning curve for RMN‐guided ablation.

Methods

A total of 1003 catheter ablation procedures using RMN for conditions including supraventricular ventricular tachycardia, atrial tachyarrhythmias, and premature ventricular contraction/ventricular tachycardia (PVC/VT) were retrospectively analyzed from an ablation registry. Procedural outcomes, including procedure time, mapping time, X‐ray time, and RF time, were assessed. The complications were classified into two categories: major and minor. A subanalysis was used to illustrate the learning curve of RMN‐guided ablation by assessing procedure time and total X‐ray time of 502 atrial fibrillation (AF) ablation procedures.

Results

Among these procedures, 556 (55.4%) were AF and 290 (28.9%) were PVC/VT. Electrical pulmonary vein isolation was achieved in 99.0% of AF procedures, and acute success reached 90.3% in PVC/VT procedures. The overall complication rate was 0.5%. In the subanalysis of AF procedures, the overall procedure time and X‐ray time of procedures were short (125.9 ± 54.6 and 5.3 ± 3.9 minutes, respectively) and proceeded to decrease from the initial 30 procedures to about 300 procedures, where the learning curve reached plateau, demonstrating maximum procedure efficiency.

Conclusions

RMN‐guided ablation is safe, as verified by very low overall complication rate and reduced X‐ray time. In our study, even the first AF procedures had a relatively low procedure time and total X‐ray time, and procedure efficiency improved during the learning curve.

Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control

AIMS

This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).

METHODS

146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up.

RESULTS

Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm², P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77).

CONCLUSIONS

Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.

Role of Contact Force Sensing in Catheter Ablation of Cardiac Arrhythmias: Evolution or History Repeating Itself?

Adequate catheter-tissue contact facilitates efficient heat energy transfer to target tissue. Tissue contact is thus critical to achieving lesion transmurality and success of radiofrequency (RF) ablation procedures, a fact recognized more than 2 decades ago. The availability of real-time contact force (CF)-sensing catheters has reinvigorated the field of ablation biophysics and optimized lesion formation. The ability to measure and display CF came with the promise of dramatic improvement in safety and efficacy; however, CF quality was noted to have just as important an influence on lesion formation as absolute CF quantity. Multiple other factors have emerged as key elements influencing effective lesion formation, including catheter stability, lesion contiguity and continuity, lesion density, contact homogeneity across a line of ablation, spatiotemporal dynamics of contact governed by cardiac and respiratory motion, contact directionality, and anatomic wall thickness, in addition to traditional ablation indices of power and RF duration. There is greater appreciation of surrogate markers as a guide to lesion formation, such as impedance fall, loss of pace capture, and change in unipolar electrogram morphology. In contrast, other surrogates such as tactile feedback, catheter motion, and electrogram amplitude are notably poor predictors of actual contact and lesion formation. This review aims to contextualize the role of CF sensing in lesion formation with respect of the fundamental principles of biophysics of RF ablation and summarize the state-of-the-art evidence behind the role of CF in optimizing lesion formation.

Troponin T release comparing manually or magnetically guided radiofrequency ablation for AVNRT- a MAGMA AVNRT substudy

OBJECTIVES

Catheter ablation is regarded as first-line therapy for symptomatic atrioventricular nodal reentry tachycardia (AVNRT). Ablation induces intended myocardial damage and the extent of myocardial damage may differ between ablation methods. The objective of this MAGMA AVNRT(NCT00875914) substudy was to compare high-sensitive cardiac troponin T (hs-cTnT) levels as a surrogate marker for myocardial damage after manually guided (MAN) AVNRT ablation versus AVNRT ablation using remote magnetic navigation (RMN).

DESIGN

In total, 70 patients (mean age 44 ± 14 years, 26% male) undergoing catheter ablation for AVNRT in the MagMa-AVNRT-Trial were randomized to remote magnetic navigation (n = 34, 49%) or manually guided catheter ablation (n = 36, 51%). hs-cTnT was measured the day after the procedure.

RESULTS

The median follow-up time was 6.2 ± 1.1 years. Acute success was 100% in both groups. hs-cTnT release was significantly lower in the remote magnetic navigation group (52 ng/L versus 95 ng/L, p < .01), even though the ablation time was longer and number of applications was higher with remote magnetic navigation (4.2 min vs 2.8 min, p = .017; 4.9 vs 3.3 applications, p = .01). hs-cTnT released per minute ablation time was also lower with remote magnetic navigation (12 ng/L versus 34 ng/L, p < .01). Both groups exhibited similar clinical long-term follow up regarding recurrence and complications.

CONCLUSION

Remote magnetic navigation controlled catheter ablation of AVNRT has similar clinical outcome, but leads to less hs-cTnT release than manually guided catheter ablation. This might correspond to less unintended myocardial damage with RMN, which might be advantageous in complex ablation procedures.