Mapping and ablation of ventricular arrhythmias with magnetic navigation: comparison between 4- and 8-mm catheter tips

• Published in: Journal of interventional cardiac electrophysiology 2009-11, Vol.26 (2), p.133-137
• Main Authors: Di Biase, Luigi, Burkhardt, J. David, Lakkireddy, Dhanunjaya, Pillarisetti, Jayasree, Baryun, Esam Nuri, Biria, Mazda, Horton, Rodney, Sanchez, Javier, Gallinghouse, G. Joseph, Bailey, Shane, Beheiry, Salwa, Hongo, Richard, Hao, Steven, Tomassoni, Gery, Natale, Andrea
• Format: Article
• Language: English
• Subjects: Body Surface Potential Mapping - instrumentation; Cardiology; Catheter Ablation - instrumentation; Equipment Design; Equipment Failure Analysis; Female; Humans; Magnetics - instrumentation; Male; Medicine; Medicine & Public Health; Middle Aged; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - surgery; Transducers; Treatment Outcome
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-009-9416-5

Introduction Remote magnetic navigation (RMN) has been reported as an effective and safe tool to overcome the need for advanced operator skill in the treatment of complex arrhythmias. We report a series of patients undergoing radiofrequency catheter ablation of ventricular arrhythmias (VAs) using RMN with either a 4-mm catheter tip or an 8-mm catheter tip at four different centers. Methods Sixty-five patients with clinical and symptomatic history of Vas were included. Two different magnetic catheters were used to deliver radiofrequency applications remotely. When ablation with the RMN catheters failed, a manual irrigated catheter was used to eliminate the VAs. Post-ablation pacing maneuvers were utilized to verify the inducibility of Vas. Results Twenty-eight patients (43%) had ischemic cardiomyopathy [coronary artery disease (CAD)], 16 patients (25%) had non-ischemic cardiomyopathy [idiopathic dilated cardiomyopathy (IDC)], and 21 patients (32%) had structurally normal hearts (SNH) or right ventricle outflow tract tachycardia (RVOT). In patients with structural heart disease (CAD, IDC), success was achieved in 22% with the 4-mm catheter tip and in 59% with the 8-mm catheter tip ( p  = 0.014). In patients with SNH/RVOT, success was achieved in 85% with the 4-mm catheter tip and in 87% with the 8-mm catheter tip ( p  = 1.00). Conclusions Our findings showed that, with RMN, there is an increased success related to the catheter tip utilized. However, in patients with right ventricular outflow origin, the standard 4-mm tip provided adequate lesions for successful ablation in most patients.