GW24-e2281 Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: a randomised controlled study

Objectives There has been no randomised controlled study to prospectively compare the performance and clinical outcomes of remote magnetic control (RMC) versus manual catheter control (MCC) during ablation of right ventricular outflow tract (RVOT) ventricular premature complexes (VPC) or tachycardia (VT). This study prospectively evaluated the efficacy and safety of using either RMC versus MCC for mapping and ablation of RVOT VPC/VT. Methods Thirty consecutive patients with idiopathic RVOT VPC/VT were referred for catheter ablation and randomised into either RMC or MCC group. A non-contact mapping system (NCM) was deployed in the RVOT to identify origins of VPC/VT. Conventional activation and pace-mapping was performed to guide ablation. If ablation performed using one mode of catheter control was acutely unsuccessful, the patient crossed over to the other group. The primary endpoints were patients and physicians fluoroscopy exposure and times. Results Mean procedural times were similar between RMC and MCC groups. The fluoroscopy exposure and times for both patients and physicians were much lower in RMC group than in the MCC group. Ablation was acutely successful in 14/15 patients in the MCC group and 10/15 in the RMC group. Following cross-over, acute success was achieved in all patients. No major complications occurred in either group. During 22 months of follow-up, RVOT VPC recurred in 2 RMC patients. Conclusions RMC navigation significantly reduces patients’ and physicians’ fluoroscopy times by 50.5% and 68.6% respectively when used in conjunction with a NCM to guide ablation of RVOT VPC/VT.