Journal of Interventional Cardiac Electrophysiology

, Volume 49, Issue 3, pp 227–235 | Cite as

A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation

  • Mohit K. Turagam
  • Donita Atkins
  • Roderick Tung
  • Moussa Mansour
  • Jeremy Ruskin
  • Jie Cheng
  • Luigi Di Biase
  • Andrea Natale
  • Dhanunjaya Lakkireddy



There are limited studies on the safety and efficacy of remote magnetic navigation (RMN) versus manual navigation (MAN) in ventricular tachycardia (VT) ablation.


A comprehensive literature search was performed using the keywords VT ablation, stereotaxis, RMN and MAN in Pubmed, Ebsco, Web of Science, Cochrane, and Google scholar databases.


The analysis included seven studies (one randomized, three prospective observational, and three retrospective) including 779 patients [both structural heart disease (SHD) and idiopathic VT] comparing RMN (N = 433) and MAN (N = 339) in VT ablation. The primary end point of long-term VT recurrence was significantly lower with RMN (OR 0.61, 95% CI 0.44–0.85, p = 0.003) compared with MAN. Other end points of acute procedural success (OR 2.13, 95% CI 1.40–3.23, p = 0.0004) was significantly higher with RMN compared with MAN. Fluoroscopy [mean difference −10.42, 95% CI −12.7 to −8.1, p < 0.0001], procedural time [mean difference −9.79, 95% CI −19.27 to −0.3, p = 0.04] and complications (OR 0.35, 95% CI 0.17–0.74, p = 0.0006) were also significantly lower in RMN when compared with MAN. In a subgroup analysis SHD, there was no significant difference in VT recurrence or acute procedural success with RMN vs. MAN. In idiopathic VT, RMN significantly increased acute procedural success with no difference in VT recurrence.


The results demonstrate that RMN is safe and effective when compared with MAN in patients with both SHD and idiopathic VT undergoing catheter ablation. Further prospective studies are needed to further verify the safety and efficacy of RMN.


Ventricular tachycardia Catheter ablation Stereotaxis Remote magnetic navigation and manual navigation system 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.



Ethical approval

None required.

Informed consent

Not required as this is from already published data.


  1. 1.
    Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375:111–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Reddy VY, Neuzil P, Taborsky M, Ruskin JN. Short-term results of substrate mapping and radiofrequency ablation of ischemic ventricular tachycardia using a saline-irrigated catheter. J Am Coll Cardiol. 2003;41:2228–36.CrossRefPubMedGoogle Scholar
  3. 3.
    Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101:1288–96.CrossRefPubMedGoogle Scholar
  4. 4.
    Aryana A, d’Avila A, Heist EK, et al. Remote magnetic navigation to guide endocardial and epicardial catheter mapping of scar-related ventricular tachycardia. Circulation. 2007;115:1191–200.PubMedGoogle Scholar
  5. 5.
    Dinov B, Schonbauer R, Wojdyla-Hordynska A, et al. Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study. J Cardiovasc Electrophysiol. 2012;23:499–505.CrossRefPubMedGoogle Scholar
  6. 6.
    Szili-Torok T, Schwagten B, Akca F, et al. Catheter ablation of ventricular tachycardias using remote magnetic navigation: a consecutive case-control study. J Cardiovasc Electrophysiol. 2012;23:948–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Bauernfeind T, Akca F, Schwagten B, et al. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias. Europace. 2011;13:1015–21.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Akca F, Theuns DA, Abkenari LD, de Groot NM, Jordaens L, Szili-Torok T. Outcomes of repeat catheter ablation using magnetic navigation or conventional ablation. Europace. 2013;15:1426–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang F, Yang B, Chen H, et al. Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: a randomized controlled study. Heart Rhythm. 2013;10:1178–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Hendriks AA, Akca F, Dabiri Abkenari L et al. Safety and Clinical Outcome of Catheter Ablation of Ventricular Arrhythmias Using Contact Force Sensing: Consecutive Case Series. J Cardiovasc Electrophysiol. 2015.Google Scholar
  11. 11.
    Di Biase L, Tung R, Burkhardt JD, et al. Abstract 14384: scar homogeneization ablation in patients with ischemic cardiomyopathy: comparison between remote magnetic navigation and manual ablation. Circulation. 2015;132:A14384–4.Google Scholar
  12. 12.
    Aliot EM, Stevenson WG, Almendral-Garrote JM, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm. 2009;6:886–933.CrossRefPubMedGoogle Scholar
  13. 13.
    Juni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of controlled clinical trials. BMJ. 2001;323:42–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Wu Y, Li KL, Zheng J, et al. Remote magnetic navigation vs. manual navigation for ablation of ventricular tachycardia: a meta-analysis. Neth Heart J. 2015;23:485–90.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Davis DR, Tang AS, Gollob MH, Lemery R, Green MS, Birnie DH. Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures. Pacing Clin Electrophysiol: PACE. 2008;31:893–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Wittkampf FH, Nakagawa H. RF catheter ablation: lessons on lesions. Pacing Clin Electrophysiol: PACE. 2006;29:1285–97.CrossRefPubMedGoogle Scholar
  17. 17.
    Tung R, Vaseghi M, Frankel DS, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study. Heart Rhythm. 2015;12:1997–2007.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Aagaard P, Natale A, Briceno D, et al. Remote magnetic navigation: a focus on catheter ablation of ventricular arrhythmias. J Cardiovasc Electrophysiol. 2016;27(Suppl 1):S38–44.CrossRefPubMedGoogle Scholar
  19. 19.
    de Groot NM. Remote magnetic catheter navigation: more than just bells and whistles? Neth Heart J. 2013;21:294–5.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Faddis MN, Blume W, Finney J, et al. Novel, magnetically guided catheter for endocardial mapping and radiofrequency catheter ablation. Circulation. 2002;106:2980–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Ray IB, Dukkipati S, Houghtaling C, et al. Initial experience with a novel remote-guided magnetic catheter navigation system for left ventricular scar mapping and ablation in a porcine model of healed myocardial infarction. J Cardiovasc Electrophysiol. 2007;18:520–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Roudijk RW, Gujic M, Suman-Horduna I, Marchese P, Ernst S. Catheter ablation in children and young adults: is there an additional benefit from remote magnetic navigation? Neth Heart J. 2013;21:296–303.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kim AM, Turakhia M, Lu J, et al. Impact of remote magnetic catheter navigation on ablation fluoroscopy and procedure time. Pacing Clin Electrophysiol: PACE. 2008;31:1399–404.CrossRefPubMedGoogle Scholar
  24. 24.
    Di Biase L, Tung R, Szili-Torok T, et al. MAGNETIC VT study: a prospective, multicenter, post-market randomized controlled trial comparing VT ablation outcomes using remote magnetic navigation-guided substrate mapping and ablation versus manual approach in a low LVEF population. J Interv Card Electrophysiol. 2017:1–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Mohit K. Turagam
    • 1
  • Donita Atkins
    • 2
  • Roderick Tung
    • 3
  • Moussa Mansour
    • 4
  • Jeremy Ruskin
    • 4
  • Jie Cheng
    • 5
  • Luigi Di Biase
    • 6
  • Andrea Natale
    • 7
  • Dhanunjaya Lakkireddy
    • 2
  1. 1.Division of Cardiovascular MedicineUniversity of Missouri Hospital and ClinicsColumbiaUSA
  2. 2.Division of Cardiovascular Diseases, Cardiovascular Research InstituteUniversity of Kansas Hospital & Medical CenterKansas CityUSA
  3. 3.University of Chicago Medicine, Pritzker School of MedicineChicagoUSA
  4. 4.Massachusetts General HospitalBostonUSA
  5. 5.Texas Heart InstituteHoustonUSA
  6. 6.Albert Einstein College of MedicineNew YorkUSA
  7. 7.Texas Cardiac Arrhythmia Institute at St. David’s Medical CenterAustinUSA

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