Radiofrequency ablation of supraventricular tachycardias in patients with congenital heart disease and difficult access to the chamber of interest using remote magnetic navigation

Abstract

Background: Supraventricular tachycardia (SVT) ablation in patients with adult congenital heart disease (ACHD) can be challenging. Remote magnetic navigation (RMN) guided ablation with three-dimensional (3D) image integration may provide benefit in patients with complex anatomy. Methods: SVT ablation procedures in patients with complex defects and difficult access to the chamber of interest were retrospectively identified (Table 1). All the procedures were done with retrograde aortic and/or superior venous accesses using RMN guided mapping/ablation and 3D image integration. Results: A total of 45 SVT ablation procedures in 32 patients (age 32±13 years, 18 male) were analysed. A median of 1 (1-5) different SVTs were targeted by procedure using 1.6±0.6 diagnostic catheters. The median procedure time was 252 (36 - 485) minutes with a mean 28.8±18.5 radiofrequency applications. Median fluoroscopy time was 4.2 (0.6 - 15.5) minutes. Acute success was 82.2% and SVT free rate was 75.8% during a mean follow-up of 20 months. View this table: Table 1 Conclusion: The ablation of SVTs in patients with complex congenital heart disease and difficult access to the chamber of interest is feasible using remote magnetic navigation and 3D-image integration with satisfactory success rates and remarkably low fluoroscopy exposure.