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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Remote Magnetic Navigation

Human Experience in Pulmonary Vein Ablation

Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

Manuscript received February 14, 2007; revised manuscript received April 17, 2007, accepted May 14, 2007.

^_* Reprint requests and correspondence: Dr. Andrea Natale, Head, Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195. (Email: natalea{at}ccf.org).

Objectives: We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF).

Background: This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill.

Methods: After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs).

Results: Using the coordinate approach, the target location was reached in only 60% of the sites, whereas by using the wand approach 100% of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8%) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33%) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 ± 2 months, recurrence was seen in 5 patients (22%) with complete PVAI and in 20 patients (90%) with incomplete PVAI.

Conclusions: Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.

Abbreviations and Acronyms   AF = atrial fibrillation   CPVA = circumferential pulmonary vein ablation   EGM = electrogram   ICE = intracardiac echocardiography   LA = left atrium/atrial   MN = magnetic navigation   PV = pulmonary vein   PVAI = pulmonary vein antrum isolation   RF = radiofrequency

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