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Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures
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Dipole charge density mapping integrated in remote magnetic navigation: First-in-human feasibility study.

Rita B Gagyi1, Anna M E Noten1, Sip Wijchers1

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International Journal of Cardiology. Heart & Vasculature
|July 28, 2022
PubMed
Summary

The AcQMap-RMN system is as safe as CARTO-RMN for robotic magnetic navigation ablation procedures. AcQMap-RMN improves outcomes for persistent atrial fibrillation and atrial tachycardias, despite initial increases in procedure time and fluoroscopy use.

Keywords:
Atrial arrhythmiaCatheter ablationMapping and imagingRobotic navigation

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Area of Science:

  • Cardiovascular Medicine
  • Medical Technology
  • Electrophysiology

Background:

  • Robotic magnetic navigation (RMN) enhances catheter precision and stability in cardiac procedures.
  • Historically, CARTO 3 mapping system (CARTO-RMN) was the sole RMN integration.
  • A new high-resolution non-contact mapping system (AcQMap) is now integrated with RMN (AcQMap-RMN) for treating atrial fibrillation (AF) and atrial tachycardias (AT).

Purpose of the Study:

  • To compare the safety, efficiency, and efficacy of AcQMap-RMN versus CARTO-RMN guided catheter ablation (CA).

Main Methods:

  • A prospective registry comparing procedural data from 238 patients (147 AcQMap-RMN, 91 CARTO-RMN).
  • Evaluation of primary endpoint: safety (procedural complications).
  • Assessment of secondary endpoints: procedure duration, fluoroscopy use, and recurrence rates at 12 months.

Main Results:

  • AcQMap-RMN demonstrated non-inferior safety compared to CARTO-RMN (3.4% vs. 3.3% complications).
  • AcQMap-RMN procedures were longer with increased fluoroscopy use (172.5 min vs. 129.6 min; 181.0 mGy vs. 131.0 mGy), but these decreased with experience.
  • AcQMap-RMN showed improved outcomes for persistent AF (36.6% recurrence vs. 75.0%) and AT (17.1% recurrence vs. 38.7%), and was non-inferior for paroxysmal AF (6.6% vs. 12.5%).

Conclusions:

  • AcQMap-RMN integration maintains the safety of RMN-guided ablations.
  • The AcQMap-RMN system enhances CA outcomes for persistent AF and AT.
  • Initial implementation of AcQMap-RMN requires a learning curve, involving longer procedures and higher fluoroscopy exposure.