Abstract 14384: Scar Homogeneization Ablation in Patients With Ischemic Cardiomyopathy: Comparison Between Remote Magnetic Navigation and Manual Ablation

Abstract

Introduction: Remote magnetic navigation (RMN) and ablation with the magnetic irrigated tip catheter has been reported as a feasible and safe technique for the treatment of ventricular arrhythmias (VA). We compared the procedural benefit and the outcomes of patients with ischemic cardiomyopathy (IC) undergoing VAs ablation with the RMN versus the manual approach. Methods: Consecutive pts with IC undergoing VAs ablation both with RMN and with manual ablation at different Institutions were enrolled. Substrate mapping and ablation technique with scar homogenization were utilized for ablation with the end point of elimination of all abnormal electrograms within and or around the scar area. Procedural data and outcomes were analyzed. Post-ablation pacing maneuvers and isoproterenol were used to verify Vas inducibility. Results: A total of 218 consecutive pts (85.3% male, 69.2±7.7 years, LVEF 30.6±8.2) with IC were included with 80 pts undergoing manual ablation while 138 pts underwent RMN ablation. Patients with a scar size < 60 cm2 at the 3D voltage mapping system were excluded. The mean scar size was 140 ± 61 cm2. VT was inducible in 83% pts with a cycle length of 352.1±70.7 msec. The density of the substrate map was higher in the RMN group when compared to the manual ablation group (553±118 vs 347±97, p<0.001). Acute ablation success was achieved in 217 (99.5%) of pts. The mean procedural duration and fluoroscopy time was 255.8±116.6 min and 34.8±22.9 min respectively. The mean mapping time was lower in the RMN group (80.3 ± 13.8 min) compared to the manual ablation group (96.1 ± 20.3 minutes, p < 0.001), while the radiofrequency time was lower in the manual ablation group(66.1 ± 27.3 min vs. 74.4 ± 20.7 min, p=0.02). At 15.4±6.8 months follow-up the success rate in the RMN group was 81.2% (112) while in the manual ablation group 55 (69%) pts were recurrence free (p=0.037). There was one pericardial tamponade which required pericardiocentesis in the manual ablation group. Conclusion: This study shows that VAs ablation using RMN in pts with IC and a scar size greater than 60 cm2 increases success rate at follow up when compared to manual ablation. The better outcome might be due to the higher amount of time dedicated to RF applications to achieve scar homogenization rather than mapping