Key result
Remote magnetic navigation-guided ablation achieved acute procedural success in 93.8% of patients with ventricular arrhythmias of right ventricular outflow tract origin, with no procedure-related complications.
Why the study?
Optimizing ablation strategies to improve success rates for ventricular arrhythmias from the RVOT remains challenging, particularly given that some originate from the pulmonary sinus cusp region.
Does a strategy of remote magnetic navigation-guided ablation preferentially below the pulmonary valve improve procedural success in patients with right ventricular outflow tract ventricular arrhythmias?
Observational (n=65)
No
Does a strategy of remote magnetic navigation-guided ablation preferentially below the pulmonary valve improve procedural success in patients with right ventricular outflow tract ventricular arrhythmias?
A strategy of remote magnetic navigation-guided ablation preferentially below the pulmonary valve is highly effective and safe for treating right ventricular outflow tract ventricular arrhythmias.
Supports feasibility of remote magnetic navigation for RVOT VA ablation; leaves open need for randomized comparisons to manual approaches.
The optimized strategy to further increase the success rate of ablation for ventricular arrhythmias (VAs) from the right ventricular outflow tract (RVOT) is challenging. Recent studies have shown that the pulmonary sinus cusp (PSC) region may be the origin of certain RVOT VAs. We evaluated the efficacy of preferential ablation below the pulmonary valve (PV) and alternated radiofrequency delivery in the PSC using remote magnetic navigation (RMN). Sixty-five (65) consecutive patients experiencing VAs with RVOT-like appearance were included in this study. Mapping and ablation were preferentially performed below the PV. Ablation in the PSC would only be attempted when intensified ablation below the PV could not eliminate VAs. Finally, if ablation in the RVOT region failed, the aortic sinus cusp (ASC) would be mapped. Sixty-one (61) of 65 (93.8%) patients achieved procedural success. Except 7 cases of which the VAs were ablated in the ASC, the rest 54 VAs were thought to be originate from the RVOT region. Fifty (50) of 54 VAs were successfully ablated below the PV, and in the presence of a local special signal in the bipolar electrogram a more aggressive ablation was required. Subsequent ablation in the PSC with assistance of the RMN system achieved success in the remaining 4 patients. No complications occurred in this study. Our strategy of using RMN-guided ablation below the PV for VAs of RVOT origin was proved to be effective. PSC mapping and ablation using a magnetic catheter may provide the optimal strategy for treating these types of arrhythmias.
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Xie et al. (2020) conducted an observational in Ventricular arrhythmias from right ventricle outflow tract (n=65). Remote magnetic navigation-guided ablation was evaluated on Acute procedural success. Remote magnetic navigation-guided ablation achieved acute procedural success in 93.8% of patients with ventricular arrhythmias of right ventricular outflow tract origin, with no procedure-related complications.
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