Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

The prevalence of congenital heart diseases is nine persons per 1000. Sometimes, congenital heart disease needs surgical correction. The long-term postoperative period is often associated with complex heart rhythm disturbances like ectopic or re-entry tachycardia. These cases, in combination with difficult anatomy, results in challenges during interventional treatment. Catheter ablation has been demonstrated as safe and effective in different types of arrhythmia treatments in such patients, including paediatric cohorts. Despite these facts, several important problems regarding using current technologies are still unresolved. Remote magnetic navigation showed good results regarding localisation of arrhythmogenic zones during treatment of complex heart rhythm disturbances. The objective of the present article is to review recently published data in this area and experience of Meshalkin National Medical Research Center in heart rhythm disturbances treatment using remote magnetic navigation in patients after surgical correction of congenital heart disease.Received 28 September 2020. Revised 25 December 2020 г. Accepted 30 December 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: A.B. Romanov, A.M. Chernyavskiy Drafting the article: V.V. Beloborodov, А.V. Ponomarenko, E.А. Morzhanaev Critical revision of the article: A.B. Romanov, А.V. Ponomarenko, I.L. Mikheenko, E.А. Morzhanaev, A.G. Filippenko, A.M. Chernyavskiy Final approval of the version to be published: V.V. Beloborodov, N.А. Yelemessov, А.V. Ponomarenko, E.А. Morzhanaev, A.G. Filippenko, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov

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Radiofrequency ablation of supraventricular tachycardias in patients with congenital heart disease and difficult access to the chamber of interest using remote magnetic navigation

European Heart Journal ◽

10.1093/eurheartj/eht310.p4922 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4922-P4922

Author(s):

L. Mantziari ◽

A. Ueda ◽

I. Suman-Horduna ◽

S. Y. Ho ◽

S. Babu-Narayan ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Radiofrequency Ablation ◽

Congenital Heart ◽

Magnetic Navigation ◽

Remote Magnetic Navigation ◽

Supraventricular Tachycardias

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Treatment of symptomatic atrial tachycardia in complex anatomic conditions: use and outcome of ablation in patients after damus-kaye-stansel surgery

EP Europace ◽

10.1093/europace/euab116.496 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

AJ Fischer ◽

SY Ho ◽

S Ernst

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Aortic Valve ◽

Congenital Heart ◽

Three Dimensional ◽

Magnetic Navigation ◽

Image Integration ◽

Ventricular Ejection Fraction ◽

Remote Magnetic Navigation ◽

Dimensional Image

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial tachycardias (AT) are amongst the most frequent complications in adult patients with congenital heart disease (ACHD). Their incidence mainly depends on age and complexity of underlying defect. AT has a marked impact on morbidity and mortality and is associated with sudden cardiac death particularly in complex ACHD patients. The arrhythmic substrate can be variable from re-entry to multifocal resulting in demanding requirements for electrophysiologic ablation procedures (EP) and thus, relatively high rates of recurrence. Methods and results Retrospective analysis of ACHD patients with prior Damus-Kaye-Stansel (DKS) surgery treated at one of the largest specialized tertiary centers for ACHD patients worldwide. Analysis focussed on occurrence of AT, respective treatment and outcome of EP. Over a median observation time of 15 years, 13 patients with prior DKS surgery and complex congenital heart defects of different types but uniformly Fontan circulation, were identified (median age 22.0 years (IQR 20.5 – 25.5), 76.9% male, 92.3% NYHA Class I, median systemic ventricular ejection fraction 58.5%, 69.2% extracardiac tunnel). Seven patients (53.8%) presented with symptomatic AT (median cyclic length 440 ms (IQR 360.0 – 517.5)). Of these, six patients underwent EP. Median procedure time was 180.5 min (IQR 160.8 – 274.5), median fluoroscopy time 1.56 min (IQR 0.51 – 4.73) and radiofrequency time 851 sec (265.0 -2005.0). Remote magnetic navigation was used to access ablation site through a retrograde access via the aortic as well as the neo-aortic valve. Three-dimensional image integration aided in mapping and ablation. Throughout the procedure as well as in follow-up visits, no reportable complications were observed. After a mean of 1.5 procedures, all analysed patients stayed complaint-free throughout a median time-interval of 13 months. Conclusion AT are frequent in complex univentricular situations after Damus-Kaye-Stansel surgery (53.8%). Although more than one procedure (mean 1.5) was necessary to achieve satisfactory results even in experienced hands, EP appears to be an appropriate treatment strategy in this young and otherwise healthy patient cohort. According to our analysis, EP is feasible and safe in centers with knowledge of specific anatomic characteristics of congenital heart disease and when the appropriate technical infrastructure is present. Access to ablation site was performed by remote magnetic navigation in the majority of procedures. The floppy catheter was navigated through the neo-aortic as well as through the aortic valve without observable peri- or postinterventional complications. Mapping with three-dimensional image integration facilitated EP and led to a relatively low radiation exposure with the known benefits for the patient as well as for the healthcare professionals involved in the procedure. Abstract Figure.

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