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
Affiliations
Richard G. Bennett
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
Timothy Campbell
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
Ashish Sood
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
Ashwin Bhaskaran
Department of Cardiology, Westmead Hospital, Sydney, Australia
Kasun De Silva
Department of Cardiology, Westmead Hospital, Sydney, Australia
Lloyd Davis
Department of Cardiology, Westmead Hospital, Sydney, Australia
Pierre Qian
Department of Cardiology, Westmead Hospital, Sydney, Australia
Gopal Sivagangabalan
Department of Cardiology, Westmead Hospital, Sydney, Australia
Mark J. Cooper
Department of Cardiology, Westmead Hospital, Sydney, Australia
Clara K. Chow
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
Aravinda Thiagalingam
Department of Cardiology, Westmead Hospital, Sydney, Australia
A. Robert Denniss
Department of Cardiology, Westmead Hospital, Sydney, Australia
Stuart P. Thomas
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
Eddy Kizana
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Institute of Medical Research, Westmead, Sydney, New South Wales, Australia
Saurabh Kumar
Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia; Corresponding author.
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.
