Abstract 14930: Contribution of Remote Magnetic Navigation to Supraventricular Tachycardia Ablation in Complex Congenital Heart Diseases
Aim To assess the contribution of remote magnetic navigation (RMN) and three-dimensional (3D) mapping and image integration in adult congenital heart disease (ACHD) patients through reviewing our experiences of supraventricular tachycardia (SVT) ablation.
Background Three-dimensional electroanatomic mapping system (EMS) plays an important role in ablation procedure in ACHD patients. RMN in conjunction with 3D-image integration could also contribute to successful outcome, especially in patients with limited accessibility and mapping difficulties.
Methods A total of 154 SVT ablation procedures using 3D-EMS in 116 ACHD patients (mean age 41 years, male 76) were reviewed and classified into three groups; Group A; manual mapping and ablation (60 procedures), Group B; RMN-guide mapping and ablation with normal femoral vein access (49), and Group C; RMN-guide mapping and ablation with difficult access (45). Procedure parameters and outcomes were assessed.
Results Group A included relatively simple anomalies such as atrial septal defect or tetoralogy of Fallot and group B was dominated by Fontan patients. Group C included more complex heart defect such as total cavo-pulmonary connection and previous atrial switch surgery or interrupted inferior venous access. Retrograde aortic access or superior venous accesses were exclusively used in group C. Image integration was used more frequently in group C (99.8%), compared to group A and B (P=0.003 in B vs C, p<0.001 in A vs C). A total of 228 SVTs were targeted for ablation. Group B and C tended to have more inducible SVTs than group A. Acute success was achieved 91.5 %, 83.7 % and 82.2% in each group respectively (p=NS). In group C, fluoroscopy time was the shortest (median 4.2 min) (p<0.001, A vs C) despite the longer procedure time (median 253 min) (p<0.001 in A vs C).
Conclusion RMN and 3D-image integration in addition to 3D-EMS facilitated safe and feasible catheter ablation procedures even in patients with complex intra-/extracardiac anomalies. As an additional benefit, the combination of these technologies resulted in very low fluoroscopy exposure.
- © 2012 by American Heart Association, Inc.