RMN-guided CTI ablation achieved complete bidirectional isthmus block in 84% of cases versus 91% with conventional manual ablation (P=0.52), but was associated with prolonged procedure times.
RCT (n=90)
Does remote magnetic catheter navigation improve procedural success or reduce procedure times compared to conventional manual ablation in patients undergoing CTI ablation for atrial flutter?
RMN-guided CTI ablation reduces radiation exposure but significantly prolongs procedure times and may be less effective long-term compared to conventional manual ablation.
Absolute Event Rate: 84% vs 91%
p-value: p=0.52
BACKGROUND: Conventional catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter is a widely applied standard therapy. Remote magnetic catheter navigation (RMN) may provide benefits for different ablation procedures, but its efficacy for CTI ablation has not been evaluated in a randomized, controlled trial. METHODS AND RESULTS: Ninety patients undergoing de novo ablation of atrial flutter were randomly assigned to conventional manual (n=45) or RMN-guided (n=45) CTI ablation with an 8-mm-tip catheter. Complete bidirectional isthmus block was achieved in 84% (RMN) and 91% (conventional catheter ablation) of the cases (P=0.52). RMN was associated with shorter fluoroscopy time (median, 10.6 minutes; interquartile range IQR, 7.6 to 19.9, versus 15.0 minutes; IQR, 11.5 to 23.1; P=0.043) but longer total radiofrequency application (17.1 minutes; IQR, 8.6 to 25, versus 7.5 minutes; IQR, 3.6 to 10.9; P20 minutes) or unsuccessful ablation. CONCLUSIONS: RMN-guided CTI ablation is associated with reduced radiation exposure but prolonged ablation and procedure times as compared with conventional catheter navigation. Our findings suggest that ablation lesions produced with an RMN-guided 8-mm catheter are less effective irrespective of CTI anatomy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00560872.
Vollmann et al. (2009) conducted an RCT in Common-Type Atrial Flutter (n=90). Remote magnetic catheter navigation (RMN)-guided CTI ablation vs. Conventional manual CTI ablation was evaluated on Complete bidirectional isthmus block (p=0.52). RMN-guided CTI ablation achieved complete bidirectional isthmus block in 84% of cases versus 91% with conventional manual ablation (P=0.52), but was associated with prolonged procedure times.