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Multicenter, randomized comparison between magnetically navigated and manually guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia (the MagMa-AVNRT-trial)

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Abstract

Background

Remote magnetic navigation (RMN) is attributed to diminish radiation exposure for both patient and operator performing catheter ablation for different arrhythmia substrates. The purpose of this prospective, randomized study was to compare RMN with manually guided catheter ablation for AV nodal reentrant tachycardia (AVNRT) regarding fluoroscopy time/dosage, acute and long-term efficacy as well as safety.

Methods and results

A total of 218 patients with AVNRT undergoing catheter ablation at three centers (male 34%, mean age 50 ± 17 years) were randomized to a manual approach (n = 113) or RMN (n = 105) using the Niobe® magnetic navigation system. The primary study endpoint was total fluoroscopy time/dosage for patient and operator at the end of the procedure. Secondary endpoints included acute success, procedure duration, complications and success rate after 6 months. Fluoroscopy time and dosage for the patient were significantly reduced in the RMN group compared to the manual group (6 ± 6 vs. 11 ± 10 min; p < 0.001 and 425 ± 558 vs. 751 ± 900 cGycm2, p = 0.002). A reduction in fluoroscopy time/dose also applied to the operator (3 ± 5 vs. 7 ± 9 min 209 ± 444 vs. 482 ± 689 cGycm2, p < 0.001). Procedure duration was significantly longer in the RMN group (88 ± 29 vs. 79 ± 29 min; p = 0.03) and crossover from the RMN group to manual ablation occurred in 7.6% of patients (7.6 vs. 0.1%; p = 0.02). Acute success was achieved in 100% of patients in both groups. Midterm success after 6 months was 97 vs. 98% (p = 0.67). No complications occurred in both groups.

Conclusion

The use of RMN for catheter ablation of AVNRT compared to a manual approach results in a reduction of fluoroscopy time and dosage of about 50% for both patients and physicians. Acute and midterm success and safety are comparable. RMN is a good alternative to a manual approach for AVNRT ablation.

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Abbreviations

AVNRT:

Atrioventricular nodal reentrant tachycardia

RF:

Radiofrequency

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Author notes

  1. Tilko Reents and Clemens Jilek contributed equally to this work.

Authors and Affiliations

  1. Department of Electrophysiology, German Heart Center Munich, Lazarettstr. 36, 80636, Munich, Germany

    Tilko Reents, Clemens Jilek, Katharina Koch-Büttner, Verena Semmler, Felix Bourier, Marc Kottmaier, Marie Kornmayer, Stephanie Brooks, Christof Kolb, Isabel Deisenhofer & Gabriele Hessling

  2. Department of Heart disease, Haukeland University Hospital, Bergen, Norway

    Peter Schuster

  3. Department of Cardiology, Heart Center, Bad Oeynhausen, Germany

    Georg Nölker

  4. Department of Cardiology, Klinikum Coburg, Coburg, Germany

    Sonia Ammar-Busch

  5. Department of Cardiology, Ludwig Maximilian University, Munich, Germany

    Stephanie Fichtner

Authors
  1. Tilko Reents
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Correspondence to Tilko Reents.

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Reents, T., Jilek, C., Schuster, P. et al. Multicenter, randomized comparison between magnetically navigated and manually guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia (the MagMa-AVNRT-trial). Clin Res Cardiol 106, 947–952 (2017). https://doi.org/10.1007/s00392-017-1144-8

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