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J Interv Card Electrophysiol. 2017 Sep;49(3):227-235. doi: 10.1007/s10840-017-0257-3. Epub 2017 Jun 17.

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

Author information

1
Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, MO, USA.
2
Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 6616, USA.
3
University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA.
4
Massachusetts General Hospital, Boston, MA, USA.
5
Texas Heart Institute, Houston, TX, USA.
6
Albert Einstein College of Medicine, New York, NY, USA.
7
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX, USA.
8
Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 6616, USA. dlakkireddy@kumc.edu.

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.

KEYWORDS:

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

PMID:
28624892
DOI:
10.1007/s10840-017-0257-3
[Indexed for MEDLINE]

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