Section of Pacing and Electrophysiology, Division of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Heart Rhythm. 2013 Aug;10(8):1178-83. doi: 10.1016/j.hrthm.2013.05.012. Epub 2013 May 18.
No randomized controlled study has prospectively compared the performance and clinical outcomes of remote magnetic control (RMC) vs manual catheter control (MCC) during ablation of right ventricular outflow tract (RVOT) ventricular premature complexes (VPC) or ventricular tachycardia (VT).
The purpose of this study was to prospectively evaluate the efficacy and safety of using either RMC vs MCC for mapping and ablation of RVOT VPC/VT.
Thirty consecutive patients with idiopathic RVOT VPC/VT were referred for catheter ablation and randomized into either the RMC or MCC group. A noncontact mapping system was deployed in the RVOT to identify origins of VPC/VT. Conventional activation and pace-mapping was performed to guide ablation. If ablation performed using 1 mode of catheter control was acutely unsuccessful, the patient crossed over to the other group. The primary endpoints were patients' and physicians' fluoroscopic exposure and times.
Mean procedural times were similar between RMC and MCC groups. The fluoroscopic exposure and times for both patients and physicians were much lower in the RMC group than in the MCC group. Ablation was acutely successful in 14 of 15 patients in the MCC group and 10 of 15 in the RMC group. Following crossover, acute success was achieved in all patients. No major complications occurred in either group. During 22 months of follow-up, RVOT VPC recurred in 2 RMC patients.
RMC navigation significantly reduces patients' and physicians' fluoroscopic times by 50.5% and 68.6%, respectively, when used in conjunction with a noncontact mapping system to guide ablation of RVOT VPC/VT.
尚无前瞻性随机对照研究比较远程磁控（RMC）与手动导管控制（MCC）在消融右心室流出道（RVOT）室性期前收缩（VPC）或室性心动过速（VT）时的性能和临床结局。
本研究旨在前瞻性评估使用 RMC 与 MCC 进行 RVOT VPC/VT 标测和消融的疗效和安全性。
连续 30 例特发性 RVOT VPC/VT 患者接受导管消融治疗，并随机分为 RMC 或 MCC 组。在 RVOT 中部署非接触式标测系统以识别 VPC/VT 的起源。采用常规激动和起搏标测指导消融。如果使用 1 种导管控制模式进行消融未能即刻成功，则患者交叉至另一组。主要终点是患者和医生的透视曝光和时间。
RMC 和 MCC 组的平均手术时间相似。RMC 组患者和医生的透视曝光和时间均明显低于 MCC 组。MCC 组 15 例患者中的 14 例和 RMC 组 15 例患者中的 10 例消融即刻成功。交叉后，所有患者均即刻成功。两组均无重大并发症发生。在 22 个月的随访中，2 例 RMC 患者 RVOT VPC 复发。
当与非接触式标测系统联合使用以指导 RVOT VPC/VT 的消融时，RMC 导航可使患者和医生的透视时间分别显著减少 50.5%和 68.6%。
