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Remote magnetic navigation (RMN)-guided catheter ablation (CA) is a feasible treatment option for patients presenting with ischemic ventricular tachycardia (VT). Catheter-tissue contact feedback, enhances lesion formation and may consequently improve CA outcomes. Until recently, contact feedback was unavailable for RMN-guided CA. The novel e-Contact Module (ECM) was developed to continuously monitor and ensure catheter-tissue contact during RMN-guided CA. The present study aims to evaluate the effect of ECM implementation on acute and long-term outcomes in RMN-guided ischemic VT ablation. This retrospective, two-center study included consecutive ischemic VT patients undergoing RMN-guided CA from 2010 to 2017. Baseline clinical data, procedural data, including radiation times, and acute success rates were compared between CA procedures performed with ECM (ECM+) and without ECM (ECM−). One-year VT-free survival was analyzed using Cox-proportional hazards models, adjusting for potential confounders: age, left ventricular function, VT inducibility at baseline and substrate based ablation strategy. The current study included 145 patients (ECM+ N = 25, ECM− N = 120). Significantly lower fluoroscopy times were observed in the ECM+ group (9.5 (IQR 5.3–13.5) versus 12.5 min (IQR 8.0–18.0), P = 0.025). Non-inducibility of the clinical VT at the end of procedure was observed in 92% ECM+ versus 72% ECM− patients (P = 0.19). ECM guidance was associated with significantly lower VT-recurrence rates during 1-year follow-up (16% ECM+ versus 40% ECM−; multivariable HR 0.29, 95%–CI 0.10–0.69, P = 0.021, reference group: ECM−). Contact feedback by the ECM further decreases fluoroscopy exposure and improves VT-free survival in RMN-guided ischemic VT ablation. • Remote magnetic navigation (RMN) is a feasible catheter ablation technique for VTs. • The e-Contact Module (ECM) is a novel catheter-tissue contact technology for RMN. • The ECM continuously monitors and ensures catheter-tissue contact during ablation. • Patients treated with ECM guidance had significantly lower VT-recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Pulmonary artery denervation (PADN) procedure has not been applied to patients with residual chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA).Objectives: This study sought to assess the safety and efficacy of PADN using remote magnetic navigation in patients with residual CTEPH after PEA.Methods: Fifty patients with residual CTEPH despite medical therapy at least 6 months after PEA, who had mean pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance (PVR) > 400 dyn‧s‧cm-5 based on right heart catheterization were randomized to treatment with PADN (PADN group; n = 25) using remote magnetic navigation for ablation or medical therapy with riociguat (MED group; n = 25). In the MED group, a sham procedure with mapping but no ablation was performed. The primary endpoint was PVR at 12 months after randomization. Key secondary endpoint included 6-min walk test.Results: After PADN procedure, 2 patients (1 in each group) developed groin hematoma that resolved without any consequences. At 12 months, mean PVR reduction was 258 ± 135 dyn‧s‧cm-5 in the PADN group versus 149 ± 73 dyn‧s‧cm-5 in the MED group, mean between-group difference was 109 dyn‧s‧cm-5 (95% confidence interval: 45 to 171; p = 0.001). The 6-min walk test distance was significantly increased in the PADN group as compared to distance in the MED group (470 ± 84 m vs. 399 ± 116 m, respectively; p = 0.03).Conclusions: PADN in patients with residual CTEPH resulted in substantial reduction of PVR at 12 months of follow-up, accompanied by improved 6-min walk test. [ABSTRACT FROM AUTHOR]

Background: The aim of this review was to evaluate the efficacy and safety between remote magnetic navigation (RMN) and manual control navigation (MCN) for atrial fibrillation (AF) ablation.Methods: We searched the PubMed, EMBASE and Cochrane library databases using the key words AF, ablation and magnetic navigation.Results: Eighteen studies were identified in this analysis including 4046 patients comparing RMN and MCN in AF ablation, which were all non-randomized controlled studies. No significant difference of AF recurrence rate (40% vs. 38%, OR 1.00, 95% CI 0.82-1.22, p = 0. 97) and acute success rate in achieving pulmonary vein isolation (91% vs. 93%, OR 0.44, 95% CI 0.16-1.17, p = 0.10) was found between RMN and MCN. However, compared with MCN, RMN was associated with significantly lower complication rate (2% vs. 5%, OR 0.44, 95% CI 0.28-0.69, p = 0. 0003) and shorter fluoroscopy time (MD -9.71 min, 95% CI -15.80 to -3.63, p = 0.002). Procedure time (MD 47.05 min, 95% CI 27.5-66.58, p < 0.00001) and ablation time (MD 15.90 min, 95% CI 9.62-22.18, p < 0.00001) of RMN guided AF ablation were significantly longer than those of MCN.Conclusion: The results of this study suggest that RMN is as effective as MCN in achieving pulmonary vein isolation and freedom from AF recurrence, and has superior safety with less complications and shorter fluoroscopy time. [ABSTRACT FROM AUTHOR]

Background Catheter ablation of atrial fibrillation (AFib) primarily relies upon pulmonary vein isolation (PVI), but such procedures are associated with significant X-ray exposure. The newer Epoch system has been developed so as to enable more precise magnetic navigation whilst limiting X-ray exposure. Objectives This study was aimed at quantifying both exposure time and X-ray reduction with the newer Epoch system compared to Niobe II during AFib ablation procedures. Methods From November 2011 to November 2013, our last 92 consecutive patients treated with the Niobe ES (Epoch Solution; 4th generation magnetic navigation technology) system were compared with the first 92 consecutive patients treated using the Niobe II system (3rd generation magnetic navigation technology) for symptomatic drug-refractory AFib. Results Mean patient age was 59 ± 11 years (20% female), and the study population was affected by either symptomatic paroxysmal (65.2%) or persistent (34.8%) AFib. Median procedure time was 2 ± 0.5 h and median total X-ray exposure 12.3 ± 6.4 min. Procedure time (1.9 ± 0.4 vs. 2.7 ± 1 h, p < 0.0001) and X-ray duration (12 ± 4 vs. 15 ± 7 min, p = 0.001) were significantly lower with Niobe ES than with the Niobe II system. X-ray ablation exposure time was also significantly lower with the Niobe ES system than with the Niobe II system (2.9 ± 2 vs. 4 ± 3.5 min; p = 0.01). Through multivariate analysis, the only predictive factors influencing both procedure duration and X-ray exposure were found to be the Niobe ES system use and LA size. Conclusions Our study was the first to demonstrate that the new Niobe ES magnetic robotic system substantially reduced overall operating, fluoroscopy, and ablation times during AFib ablation procedure. [ABSTRACT FROM AUTHOR]

Background Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart failure (SIHF) is still limited. Methods Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success was defined as noninducibility of any sustained monophasic VT at the end of the procedure. Long-term analysis addressed VT recurrence, ICD therapies and all-cause death. ES was acutely suppressed by ablation in all patients. Results Acute ablation success was obtained in 32 of 40 (80%) patients. The procedure time and fluoroscopy time were 105 ± 27 min and 7.5 ± 4.8 min respectively. No major complications occurred during procedures. During a mean follow-up of 17.4 months, 19 patients (47.5%) remained free of VT recurrence. The percentage of patients receiving ICD shocks after ablation was lower than before ablation (30% vs 69%,P < 0.01). The mean number of ICD shocks per individual per year was reduced from 4.3 before ablation to 1.9 after ablation (P < 0.05). Ten patients died during follow-up. Conclusions Acute catheter ablation with RMN is safe and effective to suppress ES in SIHF patients. RMN-guided catheter ablation can prevent VT recurrence and significantly reduce ICD shocks, suggesting that this strategy can be used as an alternative therapy for VT storm in SIHF patients with ICDs. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 12 year-old boy, with no history of cardiac disease, was referred to our department for evaluation of an incessant accelerated idioventricular rhythm (AIVR) complicated with severe left ventricular (LV) dysfunction and cardiogenic shock. Extensive diagnostic work-up failed to reveal any structural heart disease. During electrophysiological study, AIVR originated from the right ventricular endocardial anterior wall and was successfully ablated using remote magnetic navigation. LV function showed complete recovery four weeks after the procedure. This case highlights a life-threatening evolution of an arrhythmia generally presented as a benign entity in children. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)