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

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

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

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO, USA

    Mohit K. Turagam

  2. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 6616, USA

    Donita Atkins & Dhanunjaya Lakkireddy

  3. University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA

    Roderick Tung

  4. Massachusetts General Hospital, Boston, MA, USA

    Moussa Mansour & Jeremy Ruskin

  5. Texas Heart Institute, Houston, TX, USA

    Jie Cheng

  6. Albert Einstein College of Medicine, New York, NY, USA

    Luigi Di Biase

  7. Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, TX, USA

    Andrea Natale

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  1. Mohit K. Turagam
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  2. Donita Atkins
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  3. Roderick Tung
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  4. Moussa Mansour
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  5. Jeremy Ruskin
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  6. Jie Cheng
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  7. Luigi Di Biase
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  8. Andrea Natale
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  9. Dhanunjaya Lakkireddy
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Correspondence to Dhanunjaya Lakkireddy.

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Turagam, M.K., Atkins, D., Tung, R. et al. A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation. J Interv Card Electrophysiol 49, 227–235 (2017). https://doi.org/10.1007/s10840-017-0257-3

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  • DOI: https://doi.org/10.1007/s10840-017-0257-3

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