Abstract 2743: Using Remote Magnetic Navigation for the Ablation of Arrythmia in Congenital Heart Disease
The treatment of arrhythmia in patients with transposition of great arteries (TGA) and total cavopulmonary connection (TCPC) is particularly difficult with respect to complex anatomy, scar distribution, and chamber accessibility, frequently requiring puncture of surgically created septation.
Methods A series of 10 patients (7 male, mean age 29+/−7.2yrs) with congenital heart disease (TGA 5, previous TCPC 4, other 1) were treated by utilizing the remote magnetic navigation system in conjunction with a 3D electroanatomical mapping system with preprocedure imaging. Clinical tachycardia (mean CL 280+/−59.8 ms) was mapped using remote navigation via a retrograde arterial access in all cases. Arrhythmia mechanisms included macroreentrant atrial tachycardia (MAT) (4), MAT in the pulmonary venous atrium (3), focal AT (5). All initial ablations were carried out using either an solid tip magnetic ablation catheter (6) or an irrigated tip magnetic catheter (4), resulting in termination in 9 pts. Switching to manual ablation did not permit stable access to the target area in 1 pt. Ablation was facilitated by catheter inversion of the magnetic catheter to improve contact and lesion formation. Procedure parameters are summarized in table 1⇓.
Conclusions Remote navigation in conjunction with 3D electroanatomical mapping merged with pre-procedure imaging allowed accurate delineation of the tachycardia substrate in patients with complex congenital heart disease. Permitting successful treatment with low radiation exposure by facilitating access and stable catheter positioning in conventionally difficult to reach atrio-venous compartments. Inversion of the magnetic catheter improves stability and lesion formation.