Thomas Pezawas1, Robin Ristl2, Mariusz Bilinski3, Christoph Schukro3, Herwig Schmidinger3. 1. Department of Cardiology, Medical University of Vienna, Austria. Electronic address: thomas.pezawas@meduniwien.ac.at. 2. Section of Medical Statistics, Medical University of Vienna, Austria. 3. Department of Cardiology, Medical University of Vienna, Austria.
Abstract
BACKGROUND: The aim of the study was to investigate the safety and efficacy of a single, remote-magnetic catheter navigation system (MNS) for pulmonary vein isolation (PVI). METHODS: A total of 107 PVI procedures in 71 patients with paroxysmal (32%), persistent (38%) and longstanding-persistent (30%) atrial fibrillation (AF) were analyzed. A wide area circumferential radiofrequency ablation PVI was performed with either an 8mm MNS (first 35 procedures) or an irrigated MNS (last 36 procedures) catheter. Electrical isolation was confirmed with circular pacing/sensing using the MNS catheter and a coronary sinus catheter. Our follow-up strategy in the first year and upon symptoms thereafter was: clinical check plus 12-lead ECG (100%) and 24 h-ECG recordings (76%) at 3 month intervals, trans-telephonic ECG (79%) twice daily and upon symptoms (4 weeks every 3 months), or ECG monitoring via implanted devices (9%). RESULTS: The mean procedure time at 1st PVI was 247±61 min, and mean fluoroscopy time was 44±18 min. The overall complication rate was 2%. Success rates did not differ at the 1st PVI regarding catheter type (p=0.931) but were dependent on history of AF: patients with paroxysmal AF had the highest success rates of 58% and 29% after 1 and 3 years of follow-up, respectively (p=0.0084). CONCLUSION: PVI with a single MNS catheter is safe and is associated with short fluoroscopy exposition. Despite a rigorous follow-up strategy success rates favorably compare with recently published data on hand-held PVI. Thus, multipolar catheters or a 2nd trans-septal puncture may not be mandatory.
BACKGROUND: The aim of the study was to investigate the safety and efficacy of a single, remote-magnetic catheter navigation system (MNS) for pulmonary vein isolation (PVI). METHODS: A total of 107 PVI procedures in 71 patients with paroxysmal (32%), persistent (38%) and longstanding-persistent (30%) atrial fibrillation (AF) were analyzed. A wide area circumferential radiofrequency ablation PVI was performed with either an 8mm MNS (first 35 procedures) or an irrigated MNS (last 36 procedures) catheter. Electrical isolation was confirmed with circular pacing/sensing using the MNS catheter and a coronary sinus catheter. Our follow-up strategy in the first year and upon symptoms thereafter was: clinical check plus 12-lead ECG (100%) and 24 h-ECG recordings (76%) at 3 month intervals, trans-telephonic ECG (79%) twice daily and upon symptoms (4 weeks every 3 months), or ECG monitoring via implanted devices (9%). RESULTS: The mean procedure time at 1st PVI was 247±61 min, and mean fluoroscopy time was 44±18 min. The overall complication rate was 2%. Success rates did not differ at the 1st PVI regarding catheter type (p=0.931) but were dependent on history of AF: patients with paroxysmal AF had the highest success rates of 58% and 29% after 1 and 3 years of follow-up, respectively (p=0.0084). CONCLUSION: PVI with a single MNS catheter is safe and is associated with short fluoroscopy exposition. Despite a rigorous follow-up strategy success rates favorably compare with recently published data on hand-held PVI. Thus, multipolar catheters or a 2nd trans-septal puncture may not be mandatory.