Top

Journal of Interventional Cardiac Electrophysiology

Published in:

01-09-2017

Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system

Authors: Tilman Maurer, Christian Sohns, Sebastian Deiss, Laura Rottner, Peter Wohlmuth, Bruno Reißmann, Christian H. Heeger, Christine Lemes, Johannes Riedl, Francesco Santoro, Shibu Mathew, Andreas Metzner, Feifan Ouyang, Karl-Heinz Kuck, Erik Wissner

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2017

Abstract

Purpose

The magnetic navigation system (MNS) has shown to be safe and effective for catheter ablation of atrial fibrillation (AF). However, longer procedure duration as compared to manual catheter ablation may limit its widespread use. This study aimed to assess the impact of the newest generation MNS using an optimized mapping and ablation protocol on the efficacy and safety of remote magnetic catheter (RMC)-guided pulmonary vein isolation (PVI).

Methods

This observational study included 52 patients with symptomatic AF who underwent RMC-guided PVI using the second-generation MNS Niobe II (initial 28 patients, group I) or the third-generation MNS Niobe ES in combination with an optimized mapping and ablation protocol (24 patients, group II).

Results

Acute PVI was achieved in 26/28 (93%) patients in group I and 24/24 patients (100%) in group II. Mean procedure time was 263.9 ± 81.9 min in group I and significantly lower in group II (139.7 ± 22.6 min, p < 0.01). Mean fluoroscopy time was 18.8 ± 8.7 min in group I and decreased to 7.9 ± 2.6 in group II (p < 0.01). After a median follow-up of 640.5 days (Q1 460.75; Q3 766.5), 16/24 (67%) patients undergoing RMC-guided PVI in group II remained in stable SR. No periprocedural complications were noted for either group.

Conclusions

Use of the third-generation MNS for RMC-guided PVI is safe, effective, and drastically reduced procedure times.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609–78.CrossRefPubMed

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al., American College of Cardiology/American Heart Association Task Force on Practice, G. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1–76.

Chun KR, Wissner E, Koektuerk B, Konstantinidou M, Schmidt B, Zerm T, et al. Remote-controlled magnetic pulmonary vein isolation using a new irrigated-tip catheter in patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(5):458–64.CrossRefPubMed

Koutalas E, Bertagnolli L, Sommer P, Richter S, Rolf S, Breithardt O, et al. Efficacy and safety of remote magnetic catheter navigation vs. manual steerable sheath-guided ablation for catheter ablation of atrial fibrillation: a case-control study. Europace. 2015;17(2):232–8.CrossRefPubMed

Sohns C, Bergau L, Seegers J, Luthje L, Vollmann D, Zabel M. Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation. J Interv Card Electrophysiol. 2014;41(1):75–82.CrossRefPubMed

Proietti R, Pecoraro V, Di Biase L, Natale A, Santangeli P, Viecca M, et al. Remote magnetic with open-irrigated catheter vs. manual navigation for ablation of atrial fibrillation: a systematic review and meta-analysis. Europace. 2013;15(9):1241–8.CrossRefPubMed

Sohns C, Sohns JM, Bergau L, Sossalla S, Vollmann D, Luthje L, et al. Pulmonary vein anatomy predicts freedom from atrial fibrillation using remote magnetic navigation for circumferential pulmonary vein ablation. Europace. 2013;15(8):1136–42.CrossRefPubMed

Weiss JP, May HT, Bair TL, Crandall BG, Cutler MJ, Day JD, et al. A comparison of remote magnetic irrigated tip ablation versus manual catheter irrigated tip catheter ablation with and without force sensing feedback. J Cardiovasc Electrophysiol. 2016;27(Suppl 1):S5–S10.CrossRefPubMed

Miyazaki S, Shah AJ, Xhaet O, Derval N, Matsuo S, Wright M, et al. Remote magnetic navigation with irrigated tip catheter for ablation of paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(6):585–9.CrossRefPubMed

10.

Ernst S, Ouyang F, Linder C, Hertting K, Stahl F, Chun J, et al. Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation. Circulation. 2004;109(12):1472–5.CrossRefPubMed

11.

Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al., Guidelines, E.S.C.C.f.P. 2012 Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719–47.

12.

Vollmann D, Luthje L, Seegers J, Sohns C, Sossalla S, Sohns J, et al. Remote magnetic navigation for circumferential pulmonary vein ablation: single-catheter technique or additional use of a circular mapping catheter? J Interv Card Electrophysiol. 2014;41(1):65–73.CrossRefPubMed

13.

Sanchez-Quintana D, Lopez-Minguez JR, Macias Y, Cabrera JA, Saremi F. Left atrial anatomy relevant to catheter ablation. Cardiol Res Pract. 2014;2014:289720.CrossRefPubMedPubMedCentral

14.

Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, et al., Fire, and Investigators, I.C.E. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45.

15.

Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 2010;122(23):2368–77.CrossRefPubMed

16.

Metzner A, Heeger CH, Wohlmuth P, Reissmann B, Rillig A, Tilz RR, et al. Two-year outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon: lessons from the bonus freeze protocol. Clin Res Cardiol. 2016;105(1):72–8.CrossRefPubMed

17.

Heeger CH, Wissner E, Wohlmuth P, Mathew S, Hayashi K, Sohns C, et al. Bonus-freeze: benefit or risk? Two-year outcome and procedural comparison of a “bonus-freeze” and “no bonus-freeze” protocol using the second-generation cryoballoon for pulmonary vein isolation. Clin Res Cardiol. 2016;105(9):774–82.CrossRefPubMedPubMedCentral

18.

Kuck KH, Hoffmann BA, Ernst S, Wegscheider K, Treszl A, Metzner A, et al. Impact of complete versus incomplete circumferential lines around the pulmonary veins during catheter ablation of paroxysmal atrial fibrillation: results from the Gap-Atrial Fibrillation-German Atrial Fibrillation Competence Network 1 Trial. Circ Arrhythm Electrophysiol. 2016;9(1):e003337.CrossRefPubMed

19.

de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010;55(8):725–31.CrossRefPubMed

Title: Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system
Authors: Tilman Maurer
Christian Sohns
Sebastian Deiss
Laura Rottner
Peter Wohlmuth
Bruno Reißmann
Christian H. Heeger
Christine Lemes
Johannes Riedl
Francesco Santoro
Shibu Mathew
Andreas Metzner
Feifan Ouyang
Karl-Heinz Kuck
Erik Wissner
Publication date: 01-09-2017
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2017
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0261-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Significant reduction in procedure duration in remote magnetic-guided catheter ablation of atrial fibrillation using the third-generation magnetic navigation system

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2017

The anticoagulant effect of heparin during radiofrequency ablation (RFA) in patients taking apixaban or rivaroxaban

Role of implantable cardioverter defibrillator in non-ischemic cardiomyopathy: a systematic review and meta-analysis of prospective randomized clinical trials

Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study

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

Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

Effect of supplemented intake of omega-3 fatty acids on arrhythmias in patients with ICD: fish oil therapy may reduce ventricular arrhythmia