Texas Cardiac Arrhythmia Institute at St. David Medical Center, Austin, Texas, USA.
Heart Rhythm. 2010 Aug;7(8):1029-35. doi: 10.1016/j.hrthm.2010.04.036. Epub 2010 Apr 28.
Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips.
This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC).
A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator.
Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 +/- 1.2 hours vs. 3.3 +/- 1.1 hours, P = 0.004) and RF time (24 +/- 12 minutes vs. 33 +/- 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 +/- 22 minutes vs. 26 +/- 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 +/- 2.1 months of follow-up in the study group and 18.7 +/- 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA.
This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.
远程磁导航（RMN）已被报道为一种可行且安全的映射和消融系统，可用于治疗室性心律失常（VA）。然而，使用 4 毫米和 8 毫米导管尖端的报道成功率有限。
本研究旨在报告使用 RMN 和 3.5 毫米磁开放式灌流尖端导管（OIC）对连续 110 例接受射频（RF）导管消融 VA 的患者的大型系列研究结果。
共纳入 110 例有左 VA 临床病史的连续患者。在所有情况下，均使用 OIC 进行映射和消融。当 RMN 导管消融失败时，使用手动 OIC 消除 VA。消融后起搏操作和异丙肾上腺素用于验证 VA 的可诱发性。将结果与同一操作者连续进行的 92 例手动消融患者的结果进行比较。
所有 110 例 VA 患者均进行了磁 OIC 的映射和消融。缺血性心肌病患者 33 例（30%），非缺血性心肌病患者 14 例（13%），63 例（57%）患者无结构性心脏病。所有患者均进行心内膜映射，而 36 例（33%）患者进行心内膜和心外膜映射。与手动消融相比，RMN 与较长的手术时间（2.9+/-1.2 小时与 3.3+/-1.1 小时，P=0.004）和 RF 时间（24+/-12 分钟与 33+/-18 分钟，P=0.005）相关，而透视时间明显缩短（35+/-22 分钟与 26+/-14 分钟，P=0.033）。在手术过程中，15 例患者（14%）需要交叉到手动消融。在研究组的 11.7+/-2.1 个月和手动消融组的 18.7+/-3.7 个月的随访中，分别有 85%和 86%（P=0.817）的患者无 VA。
这项连续患者的大型系列研究表明，使用 RMN 的 OIC 消融对于治疗左 VA 是有效的。
