The Use of Remote Magnetic Navigation in Catheter Ablation of Atrial Arrhythmias

Jeffrey A. Tice, MD

Disclosures

CTAF 

In This Article

Conclusion

Radiofrequency catheter ablation has been a great leap forward in the treatment of supraventricular arrhythmias. Patients can now be cured without the risks of open-heart surgery or the burden of lifelong daily medications. Long-term studies report that catheter ablation is a cost-effective therapy that improves patients' quality of life.[100] However the procedure is technically difficult and laborious. Multiple steerable catheters are advanced into the heart in order to map out the electrical pathway causing the patient's arrhythmia and then a catheter must be precisely positioned against the inside of the heart to deliver radiofrequency energy to permanently destroy tissue at the location needed to prevent abnormal electrical pathways from becoming established, while not damaging normal electrical pathways. This process requires repeated use of fluoroscopy to guide catheter placement and to avoid puncturing the heart.

Remote magnetic navigation was developed to allow more precise positioning of catheters within the heart. After the initial insertion of the catheters, they can be guided from a remote computer-controlled workstation so that the operator no longer needs to be at the patient's bedside while positioning the catheters. This decreases the operator's exposure to radiation during fluoroscopy and may reduce fatigue, because the operator does not need to wear a lead apron for hours at a time. The magnetic catheters are also much more flexible than traditional steerable catheters, which may decrease the risk for cardiac perforation and tamponade.

Early case series[58–64] reported that remote magnetic navigation could effectively treat many arrhythmias with few complications, although the first report on the treatment of atrial fibrillation[60] was disappointing. Later case series and comparative studies reported more favorable results for the treatment of atrial fibrillation.[64,73,75,77,79] The case series and comparative studies[65–80] documented large decreases in operator exposure to radiation and a low incidence of procedure-related adverse events an suggested that remote magnetic navigation reduced patient exposure to radiation. This was confirmed in the two randomized trials.[81,82] However, both randomized trials were underpowered to demonstrate the equivalence of remote magnetic navigation to manual navigation for successful treatment of the arrhythmia and complications. In order to demonstrate equivalence of remote magnetic navigation to manual navigation, larger clinical trials are needed. The studies to date suggest equivalence in outcomes, with reduced radiation exposure to patients and clinicians, but considerable uncertainty remains.

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