Department of Electrophysiology, University of Leipzig, Heart Center, Leipzig, Germany.
J Cardiovasc Electrophysiol. 2010 Oct;21(10):1130-5. doi: 10.1111/j.1540-8167.2010.01777.x.
Remote magnetic catheter navigation (MNS) has been shown to be feasible and safe for radiofrequency catheter ablation of various cardiac arrhythmias. However, its safety in patients with implanted pacemakers or cardioverter-defibrillators has not yet been studied.
This retrospective case series study intends to assess the acute and short-term safety of remote MNS in patients with implanted pacemakers or cardioverter-defibrillators.
Between January 2008 and June 2009, a total of 31 patients with implanted pacemakers (n = 5) or cardioverter-defibrillators (n = 26) underwent 32 catheter ablation procedures using the remote MNS. Baseline pacing thresholds, sensed amplitudes, pacing and, if available, shock impedances as well as battery status were measured in all devices before, immediately after, and 1-3 months after catheter ablation.
After ablation, no statistically significant difference in atrial sensing (2.7 ± 1.5 mV vs 3.1 ± 1.9 mV, P = 0.18) and impedance (457 ± 104 Ω vs 449 ± 101 Ω, P = 0.37) were observed. After ablation, no statistically significant difference in right ventricular sensing (10.4 ± 3.8 mV vs 10.9 ± 4.9 mV, P = 0.43) and impedance (535 ± 118 Ω vs 534 ± 120 Ω, P = 0.913) were observed. No changes in pacing threshold could be observed in all but 2 patients with biventricular cardioverter-defibrillators who underwent ventricular tachycardia ablation in lateral wall of left ventricle near the implanted epicardial electrode.
Ablation procedures using remote MNS can be performed safely in patients with implanted devices with no significant effects on device system integrity. Long endocardial ablation close to the insertion site of the implanted epicardial left ventricular leads can affect the pacing and/or sensing characteristics of these electrodes.
远程磁导航（MNS）已被证明在各种心脏心律失常的射频导管消融中是可行且安全的。然而，其在植入起搏器或除颤器患者中的安全性尚未得到研究。
本回顾性病例系列研究旨在评估远程 MNS 在植入起搏器或除颤器患者中的急性和短期安全性。
2008 年 1 月至 2009 年 6 月，共有 31 例植入起搏器（n=5）或除颤器（n=26）的患者接受了 32 例使用远程 MNS 的导管消融术。所有设备的起搏阈值、感知幅度、起搏（如有）以及电击和电池状态均在消融术前、即刻和 1-3 个月后进行测量。
消融后，心房感知（2.7±1.5 mV 比 3.1±1.9 mV，P=0.18）和阻抗（457±104 Ω 比 449±101 Ω，P=0.37）均无统计学差异。消融后，右心室感知（10.4±3.8 mV 比 10.9±4.9 mV，P=0.43）和阻抗（535±118 Ω 比 534±120 Ω，P=0.913）均无统计学差异。除 2 例接受左心室外侧壁室性心动过速消融的双心室除颤器患者外，所有患者的起搏阈值均无变化。
在植入设备的患者中使用远程 MNS 进行消融程序是安全的，不会对设备系统完整性产生显著影响。靠近植入的左心室心外膜导联插入部位的心内膜消融可能会影响这些电极的起搏和/或感知特性。
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