Abstract
BackgroundThe purpose of this study was to prospectively evaluate the efficacy and safety of remote magnetic navigation (RMN) in comparison with manual catheter navigation (MCN) in performing ventricular tachycardia ablation.MethodsAn electronic search was performed using PubMed (1948–2013) and EMBASE (1974–2013) studies comparing RMN with MCN which were published prior to 31 December 2013. Outcomes of interest were as follows: acute success, recurrence rate, complications, total procedure and fluoroscopic times. Standard mean difference (SMD) and its 95 % confidence interval (CI) were used for continuous outcomes; odds ratios (OR) were reported for dichotomous variables.ResultsFour non-randomised studies, including a total of 328 patients, were identified. RMN was deployed in 191 patients. Acute success and long-term freedom from arrhythmias were not significantly different between the RMN and control groups (OR 1.845, 95 % CI 0.731–4.659, p = 0.195 and OR 0.676, 95 % CI 0.383–1.194, p = 0.177, respectively). RMN was associated with less peri-procedural complications (OR 0.279, 95 % CI 0.092–0.843, p = 0.024). Shorter procedural and fluoroscopy times were achieved (95 % CI -0.487 to -0.035, p = 0.024 and 95 % CI -1.467 to -0.984, p<0.001, respectively).ConclusionThe acute and long-term success rates for VT ablation are equal between RMN and MCN, whereas the RMN-guided procedure can be performed with a lower complication rate and less procedural and fluoroscopic times. More prospective randomised trials will be needed to better evaluate the superior role of RMN for catheter ablation of ventricular tachycardia.
Highlights
Catheter ablation was introduced into clinical electrophysiology in the 1980s [1]
Studies included in our metaanalysis had to meet the following criteria: (1) inclusion of patients with ventricular tachycardia (VT); (2) comparison between VT ablation obtained with the remote magnetic navigation (RMN) and manual catheter navigation (MCN) control system; and (3) report of results of at least one relevant outcome, including acute success rate in eliminating VT, procedure complications, recurrence rate, and procedural data
Disagreements between reviewers were resolved by consensus; if no agreement could be reached, it was agreed that a third author (RX.W.) would decide
Summary
Catheter ablation was introduced into clinical electrophysiology in the 1980s [1]. Considering numerous secondary effects and the low efficacy of antiarrhythmic drugs, catheter ablation is a well-established therapy of choice for many types of arrhythmias, including ventricular tachycardia (VT) [2]. All of the above-mentioned techniques are still based on manual catheter navigation (MCN) within patient hearts. Further technological developments such as electroanatomical mapping, integration of cardiac imaging, and improved catheter design have been implemented to improve the consistency of procedural outcomes [3, 4]. The purpose of this study was to prospectively evaluate the efficacy and safety of remote magnetic navigation (RMN) in comparison with manual catheter navigation (MCN) in performing ventricular tachycardia ablation. Outcomes of interest were as follows: acute success, recurrence rate, complications, total procedure and fluoroscopic times.
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