Irrigated-Tip Magnetic Catheter Ablation of AF: A Long-Term Prospective Study in 130 Patients

Feb 02, 2011
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Authors:
Pappone C, Vicedomini G, Frigoli E, et al.
Citation:
Heart Rhythm 2011;8:8-15.
Summary By:
Fred Morady, MD, FACC

Study Questions:

How safe and effective is radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) by remote magnetic navigation (RMN) using an irrigated-tip catheter?

Methods:

RFCA using RMN and a 3.5-mm-tip open-irrigation catheter was performed in 130 patients (mean age 61 years) with AF (paroxysmal in 81, persistent in 49). Circumferential pulmonary vein isolation and ablation lines across the left atrial roof, mitral isthmus, posterior wall, and cavotricuspid isthmus were performed at power settings of 20-30 W. Intense monitoring with event monitors and serial 48-hour Holter monitors was performed during follow-up. The primary efficacy endpoint was freedom from AF/atrial tachycardia (AT) off antiarrhythmic drugs.

Results:

RFCA by RMN was successful in achieving all acute ablation endpoints except in 12 patients who needed crossover to manual ablation of the mitral isthmus. There were no complications or instances of char formation. The mean total procedure time was 94 minutes and the mean fluoroscopy time was 15 minutes. Seven patients required redo RFCA for persistent AT. The primary endpoint was achieved at a mean follow-up of 15 months in 81% of patients with paroxysmal AF and 67% of patients with persistent AF. The only independent predictors of recurrent AF were a large left diameter and heart failure.

Conclusions:

RFCA of AF by RMN using an irrigated-tip catheter is safe and yields clinical results comparable to the results obtained with conventional manual RFCA.

Perspective:

The original ablation catheters available for use by RMN were not irrigated and were associated with char formation. This study demonstrates that the use of an irrigated-tip magnetic catheter has eliminated this problem.

Keywords: Magnetic Phenomena, Fluoroscopy, Heart Atria, Follow-Up Studies, Pulmonary Veins, Heart Failure, Atrial Fibrillation, Catheters, Catheter Ablation, Atrial Flutter


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