Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large‐scale single‐center study

Figures

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  FIGURE 1. An example of mapping and ablation for premature ventricular contraction (PVC) using remote magnetic navigation (RMN). A, Surface ECG of PVC and intracardiac recordings of the earliest activation site in coronary sinus (great cardiac vein). B, The combination of activation CARTO map of PVC and X‐ray image in “Navigant” system. C, Fluoroscopic view in the posterior‐anterior oblique view. The ablation catheter is pointing toward LV summit after reaching LV cavity through a transseptal approach, this forming a “reverse S‐curve.” D, Fluoroscopic view in the left anterior oblique view. The ablation catheter is pointing toward left coronary cusp through a retrograde transaortic approach. E, The ablation catheter was manipulated with RMN in the great cardiac vein. The catheter tip is equipped with three small magnets. By changing the relative orientation of the external magnets, effective control of the catheter deflection can be achieved

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  FIGURE 2. Types of cardiac arrhythmias distribution of 1003 procedures: 108 (10.8%) were supraventricular tachycardia (SVT), 49 (4.9%) were atrial tachycardia (AT) or atrial flutter (AFL), 556 (55.4%) were atrial fibrillation (AF), and 290 (28.9%) were premature ventricular contraction (PVC) or ventricular tachycardia (VT)

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  FIGURE 3. X‐ray time comparisons between atrial fibrillation (AF) and premature ventricular contraction/ventricular tachycardia (PVC/VT) group. Total: total X‐ray time; doctor: doctor's X‐ray time; control room: control room's X‐ray time

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  FIGURE 4. Procedure and total X‐ray time for all atrial fibrillation patient. Blue line: spline fit achieved by the least absolute residuals method. Transverse red dashed line: fitted time of the intercept point where the curve becomes flattened. Vertical red dashed line: the intercept point where the curve starts to drop significantly. A, Procedure time decreases along the learning curve and the curve becomes flat after 300 procedures. B, Procedure time decreased significantly from 191.4 ± 55.9 to 154.4 ± 39.8 and 121.7 ± 27.4 minutes, in P1‐3, respectively. C, Total X‐ray time reduces along the curve and the curve reach a plateau after 350 procedures. D, Total X‐ray time decreased from 9.2 ± 5.4 to 7.0 ± 3.4 and 4.6 ± 2.3 minutes, in P1‐3, respectively. ***P < .0001, *P < .05