Published Online
on September 12, 2009

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Original Article

Remote Magnetic Catheter Navigation for Cavotricuspid Isthmus Ablation in Patients with Common-Type Atrial Flutter

Dirk Vollmann¹; Lars Lüthje; Joachim Seegers; Gerd Hasenfuss and Markus Zabel

University of Göttingen, Göttingen, Germany

^* Corresponding author; email: dirkvollmann2000{at}aol.com

Background—Conventional catheter ablation (CON) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is a widely applied standard therapy. Remote magnetic catheter navigation (RMN) may provide benefits for different ablation procedures, but its efficacy for CTI-ablation has not been evaluated in a randomized controlled trial.

Methods and Results—Ninety patients undergoing de-novo ablation of AFL were randomly assigned to CON (n=45) or RMN-guided (n=45) CTI-ablation with an 8mm tip catheter. Complete bidirectional isthmus block was achieved in 84% (RMN) and 91% (CON) of the cases (p=.52). RMN was associated with shorter fluoroscopy time (median 10.6 min, inter-quartile range (IQR) 7.6-19.9 vs. 15.0 min, IQR 11.5-23.1, p=.043) but longer total radiofrequency application (17.1 min, IQR 8.6-25. vs. 7.5 min, IQR 3.6-10.9, p<.0001), ablation time (55 min, IQR 28-76 vs. 17 min, IQR 7-31, p<.0001) and procedure duration (114±35 vs. 77±24 min, p<.0001). Procedure duration in the RMN-group did not decrease significantly with case experience. Long-term procedure success, defined as achievement of complete CTI block and freedom from AFL recurrence during 6 months of follow-up, was lower in the RMN group (73% vs. 89%, p=.063). Right atrial angiography after ablation revealed no significant differences between groups in terms of right atrial diameter or CTI length, morphology and angulation. Furthermore, none of these parameters was predictive for difficult (ablation time >20min) or unsuccessful ablation.

Conclusions—RMN-guided CTI-ablation is associated with reduced radiation exposure but prolonged ablation and procedure times as compared to conventional catheter navigation. Our findings suggest that ablation lesions produced with an RMN-guided 8mm catheter are less effective, irrespective of CTI anatomy.

Key Words: atrial flutter • catheter ablation • remote navigation