Remote-Controlled Magnetic Pulmonary Vein Isolation Utilizing a New Irrigated Tip Catheter in Patients with Atrial Fibrillation

Background: Lack of an irrigated tip magnetic catheter has limited the role of remotecontrolled magnetic (RCM) navigation (Niobe II, Stereotaxis) for catheter ablation of atrial fibrillation (AF). Methods and Results: A novel 3.5-mm tip irrigated magnetic catheter (group I, Thermocool Navistar RMT, Biosense Webster) was used for 3-D left atrial reconstruction (CARTO RMT) and RCM pulmonary vein isolation (PVI). A redesigned catheter was utilized in group II. Primary endpoint was wide area circumferential PVI confirmed by spiral catheter recording during ablation; secondary endpoints included procedural data, complications and AF recurrence. Fifty-six consecutive patients [group I: 28 pts, 22 males, age: 64 (38-78) years, LA: 47 (3452) mm; paroxysmal AF: n=21, persistent AF: n=7 and group II: 28 pts, 20 males, age: 60 (24-78) years, LA: 40 (35-53) mm; paroxysmal AF: n=18, persistent AF: n=10] were included. The primary endpoint was achieved in a total of 52/56 (93%) patients. Median procedure duration was 315 (125-550) min, (group I: 370 [230-550] min; group II: 243 [125450] min). Median fluoroscopy exposure to the investigator was reduced by 31%. Tip charring in 17/28 (61%) and complications in 3/28 (11%) patients in group I resulted in a catheter redesign. SR was maintained by 35/50 (70%) pts during a median follow-up period of 545 (100-683) days. Conclusions: RCM AF ablation with real-time verification of PVI is feasible with a comparable success rate to manual ablation. Safety improved following a redesign of the catheter.