A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation
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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.
KeywordsVentricular 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.
Not required as this is from already published data.
- 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.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.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
- 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
- 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