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.

CONFLICTS OF INTEREST

None declared.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

1Hosseini SM, Rozen G, Saleh A, et al. Catheter ablation for cardiac arrhythmias. utilization and in-hospital complications, 2000 to 2013. J Am Coll Cardiol EP. 2017; 3: 1240-1248.
Google Scholar
2Faddis MN, Blume W, Finney J, et al. Novel, magnetically guided catheter for endocardial mapping and radiofrequency catheter ablation. Circulation. 2002; 106: 2980-2985.
10.1161/01.CIR.0000038704.84304.6F
PubMed Web of Science® Google Scholar
3Yokoyama K, Nakagawa H, Shah DC, et al. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008; 1: 354-362.
10.1161/CIRCEP.108.803650
PubMed Web of Science® Google Scholar
4Ernst S, Ouyang F, Linder C, et al. Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation. Circulation. 2004; 109: 1472-1475.
10.1161/01.CIR.0000125126.83579.1B
PubMed Web of Science® Google Scholar
5Bradfield J, Tung R, Mandapati R, Boyle NG, Shivkumar K. Catheter ablation utilizing remote magnetic navigation: a review of applications and outcomes. Pacing Clin Electrophysiol. 2012: 351021-1034.
Web of Science® Google Scholar
6Akca F, Önsesveren I, Jordaens L, Szili-Torok T. Safety and efficacy of the remote magnetic navigation for ablation of ventricular tachycardias: a systematic review. J Interv Card Electrophysiol. 2012; 34: 65-71.
10.1007/s10840-011-9645-2
PubMed Web of Science® Google Scholar
7Turagam MK, Atkins D, Tung R, et al. A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation. J Interv Card Electrophysiol. 2017; 49: 227-235.
10.1007/s10840-017-0257-3
PubMed Web of Science® Google Scholar
8Di Biase L, Santangeli P, Astudillo V, et al. Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: results from a large single-center case-control series. Heart Rhythm. 2010; 7: 1029-1035.
10.1016/j.hrthm.2010.04.036
PubMed Web of Science® Google Scholar
9Bauernfeind T, Akca F, Schwagten B, et al. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias. Europace. 2011; 13: 1015-1021.
10.1093/europace/eur073
PubMed Web of Science® Google Scholar
10Dinov B, Schönbauer R, Wojdyla-Hordynska A, et al. Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study. J Cardiovasc Electrophysiol. 2012; 23: 499-505.
10.1111/j.1540-8167.2011.02243.x
CAS PubMed Web of Science® Google Scholar
11Szili-Torok T, Schwagten B, Akca F, et al. Catheter ablation of ventricular tachycardias using remote magnetic navigation: a consecutive case-control study. J Cardiovasc Electrophysiol. 2012; 23: 948-954.
10.1111/j.1540-8167.2012.02340.x
PubMed Web of Science® Google Scholar
12Akca F, Theuns DA, Abkenari LD, de Groot NM, Jordaens L, Szili-Torok T. Outcomes of repeat catheter ablation using magnetic navigation or conventional ablation. Europace. 2013; 15: 1426-1431.
10.1093/europace/eut051
PubMed Web of Science® Google Scholar
13Zhang F, Yang B, Chen H, et al. Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: a randomized controlled study. Heart Rhythm. 2013; 10: 1178-1183.
10.1016/j.hrthm.2013.05.012
PubMed Web of Science® Google Scholar
14Akca F, Janse P, Theuns DA, Szili-Torok T. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. Int J Cardiol. 2015; 179: 441-448.
10.1016/j.ijcard.2014.11.105
PubMed Web of Science® Google Scholar
15Hendriks AA, Akca F, Dabiri Abkenari L, et al. Safety and clinical outcome of catheter ablation of ventricular arrhythmias using contact force sensing: consecutive case series. J Cardiovasc Electrophysiol. 2015; 26: 1224-1229.
10.1111/jce.12762
PubMed Web of Science® Google Scholar
16Kawamura M, Scheinman MM, Tseng ZH, Lee BK, Marcus GM, Badhwar N. Comparison of remote magnetic navigation ablation and manual ablation of idiopathic ventricular arrhythmia after failed manual ablation. J Interv Card Electrophysiol. 2017; 48: 35-42.
10.1007/s10840-016-0158-x
PubMed Web of Science® Google Scholar
17Bassil G, Liu CF, Markowitz SM, et al. Comparison of robotic magnetic navigation-guided and manual catheter ablation of ventricular arrhythmias arising from the papillary muscles. Europace. 2018; 20: ii5-ii10.
10.1093/europace/eux374
PubMed Web of Science® Google Scholar
18de Vries LJ, Hendriks AA, Yap SC, Theuns DAMJ, van Domburg RT, Szili-Torok T. Procedural and long-term outcome after catheter ablation of idiopathic outflow tract ventricular arrhythmias: comparing manual, contact force, and magnetic navigated ablation. Europace. 2018; 20: ii22-ii27.
10.1093/europace/euy004
PubMed Web of Science® Google Scholar
19Qian P, De Silva K, Kumar S, et al. Early and long-term outcomes after manual and remote magnetic navigation-guided catheter ablation for ventricular tachycardia. Europace. 2018; 20: ii11-ii21.
10.1093/europace/euy057
PubMed Web of Science® Google Scholar
20Shauer A, De Vries LJ, Akca F, et al. Remote magnetic navigation vs. manually controlled catheter ablation of right ventricular outflow tract arrhythmias: a retrospective study. Europace. 2018; 20: ii28-ii32.
10.1093/europace/eux382
PubMed Web of Science® Google Scholar
21Wittkampf FH, Nakagawa H. RF catheter ablation: lessons on lesions. Pacing Clin Electrophysiol. 2006; 29: 1285-1297.
10.1111/j.1540-8159.2006.00533.x
PubMed Web of Science® Google Scholar
22Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of contact force sensing in catheter ablation of cardiac arrhythmias: evolution or history repeating itself?. JACC Clin Electrophysiol. 2018; 4: 707-723.
10.1016/j.jacep.2018.03.014
PubMed Google Scholar
23Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339:b2535.
10.1136/bmj.b2535
PubMed Web of Science® Google Scholar
24Altman DG, Schulz KF, Moher D, et al. CONSORT GROUP (Consolidated Standards of Reporting Trials). The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001; 134: 663-694.
10.7326/0003-4819-134-8-200104170-00012
CAS PubMed Web of Science® Google Scholar
25Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000; 283: 2008-2012.
10.1001/jama.283.15.2008
CAS PubMed Web of Science® Google Scholar
26Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007; 7: 16.
10.1186/1472-6947-7-16
PubMed Web of Science® Google Scholar
27Demazumder D, Mirotznik M, Schwartzman D. Biophysics of radiofrequency ablation using an irrigated electrode. J Interv Card Electrophysiol. 2001; 5: 377-389.
10.1023/A:1013224110550
CAS PubMed Web of Science® Google Scholar
28Avitall B, Mughal K, Hare J, Helms R, Krum D. The effects of electrode-tissue contact on radiofrequency lesion generation. Pacing Clin Electrophysiol. 1997; 20: 2899-2910.
10.1111/j.1540-8159.1997.tb05458.x
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume44, Issue6

June 2021

Pages 1102-1114

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

Abstract

Purpose

Methods

Results

Conclusions

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

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

Abstract

Purpose

Methods

Results

Conclusions

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

Citing Literature

References

Related

Information