Mapping of Intraatrial Reentrant Tachycardias by Remote Magnetic Navigation in Patients with d‐Transposition of the Great Arteries After Mustard or Senning Procedure

Abstract

Precise mapping of IART in the complex anatomical structures after an atrial switch procedure was feasible and safe using RMN. The maneuverability of the catheter was possible even with a retrograde access crossing two valves. Further reduction of procedural and fluoroscopy times for both patients and physicians seems possible.

Remote-Controlled Magnetic Navigation and Ablation With 3D Image Integration as an Alternative Approach in Patients With Intra-Atrial Baffle Anatomy

“…The reluctance to use an 8-mm solid tip for multiple high-energy application on the systemic side was shared by other groups in similar patient cohorts. 13 …”

“…The floppy distal end of the magnetic catheter allows free alignment of the embedded magnets in the outer magnetic field, so there is virtually no risk of perforation. 13 The versatility of the magnetic catheter compensates even in situations such as total femoral venous occlusion (patient 7 in group A). Third, appropriate energy delivery at the critical site is the essential step of each ablation procedure.…”

“…13,21,36 This effect is the result of the nonfluoroscopic real-time 3D depiction of the tip of the ablation catheter on the 2 reference screens of the magnetic navigation system, thereby reducing the need to locate the ablation catheter by fluoroscopy. Compared with published reports using the same 3D mapping system but without remote navigation, the reduction in radiation exposure is within a factor of 10.…”

“…13,14 A multipolar, steerable diagnostic catheter (6F, Parahis, Biosense Webster, Brussels, Belgium) was used as the timing reference in the accessible chamber from a venous vascular access (eg, appendage of the systemic venous atrium in Mustard/Senning patients) in group A or positioned inside the TCPC in group B. A quadripolar, nonsteerable catheter was positioned in the ventricle in case of reduced atrioventricular (AV) conduction properties (Biosense Webster, Brussels, Belgium).…”

Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease

“…5,6 Currently, further technological advances, such as irrigated catheter system and remote magnetic navigation (RMN) systems, are beginning to provide further solutions for the various remaining problems encountered during electrophysiological studies in adult patients with CHD. [7][8][9] The main advantages of RMN, often used in conjunction with 3D-image integration, namely catheter maneuverability, stability, and precise delineation of the extracardiac and intracardiac anatomy can now be offered in particular situations, such as patients with limited access and mapping difficulty. 10 Previous studies have shown that acute and long-term ablation success rates decline with increasing complexity of the underlying anomaly, 5,11 which seems self-evident when the whole spectrum of adult CHD is considered.…”