Magnetic Versus Manual Catheter Navigation for Ablation of Free Wall Accessory Pathways in Children

Abstract

Background-Transcatheter ablation of accessory pathway (AP)-mediated tachycardia is routinely performed in children.Little data exist regarding the use of magnetic navigation (MN) and its potential benefits for ablation of AP-mediated tachycardia in this population. Methods and Results-We performed a retrospective review of prospectively gathered data in children undergoing radiofrequency ablation at our institution since the installation of MN (Stereotaxis Inc, St. Louis, MO) in March 2009. The efficacy and safety between an MN-guided approach and standard manual techniques for mapping and ablation of AP-mediated tachycardia were compared. During the 26-month study period, 145 patients underwent radiofrequency ablation for AP-mediated tachycardia. Seventy-three patients were ablated with MN and 72 with a standard manual approach. There were no significant differences in demographic factors between the 2 groups with a mean cohort age of 13.1±4.0 years. Acute success rates were equivalent with 68 of 73 (93.2%) patients in the MN group being successfully ablated versus 68 of 72 (94.4%) patients in the manual group (P=0.889). During a median follow-up of 21.4 months, there were no recurrences in the MN group and 2 recurrences in the manual group (P=0.388). There were no differences in time to effect, number of lesions delivered, or average ablation power. There was also no difference in total procedure time, but fluoroscopy time was significantly reduced in the MN group at 14.0 (interquartile range, 3.

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

“…For cardiac catheterization, Kim et al found a reduced fluoroscopy time when using the CARTO XP system [70]. Most of the other studies used RMN in combination with EM tracking, focusing on RMN.…”

Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation

“…Recurrence of arrhythmia and/or preexcitation on 12-lead ECG was observed only in 4% of cases in this group. Only one other study described long-term outcomes of RMN-guided AP ablation in children [9] , where fewer recurrences were observed, though this study had a significantly shorter follow-up duration and only included left free wall AP’s. Ablation of left free wall AP’s has a higher success rate compared to other locations, which is likely to be the explanation for the discrepancy with the current study’s findings [2] , [18] .…”

“…In the pediatric population, several small studies were conducted and reported first experiences with the mentioned techniques [2] , [3] , [8] , [9] , [11] , [16] , [17] . There are no large scale studies comparing ablation techniques in children, nor investigating long-term outcomes.…”

Electroanatomic mapping‐guided localization of alternative right ventricular septal pacing sites in children

“…EAMs have been developed to guide cardiac catheter navigation during adult and pediatric ablation procedures reducing or even excluding fluoroscopy exposure, as was demonstrated for the first time in 2002 by Drago et al . Currently, such EAMs are not routinely used during pacemaker implants, but there are some experiences with pacemakers and defibrillators described in adults .…”

“…EAMs have been developed to guide cardiac catheter navigation during adult and pediatric ablation procedures 12,18,19 reducing or even excluding fluoroscopy exposure, as was demonstrated for the first time in 2002 by Drago et al 20 Currently, such EAMs are not routinely used during pacemaker implants, but there are some experiences with pacemakers and defibrillators described in adults. [2][3][4][5][6][7] The use of EAM in pediatric patients was first reported in a retrospective study by Silver et al 8 EAM reduced radiation exposure for patients (and physicians), and…”