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BACKGROUND: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachyarrhythmia (VT) ablations have not been studied for their long-term efficacy. PURPOSE: The aim of this study was to compare CF ablation to manual ablation (MAN) and remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long-term outcome. METHODS: A total of 239 consecutive patients who underwent VT ablation with the use of MAN, CF, or RMN catheters were included in this single-center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications, and VT recurrences at follow-up. The median follow-up period was 25 months. RESULTS: Acute success was achieved in 182 out of 239 procedures (76%). Acute success in manual ablation, CF ablation and RMN ablation was 71%, 71%, and 86%, respectively (P = 0.03). Major complications occurred in 3.3% and there were less major complications (P = 0.04) in the RMN group. After an initial successful procedure, 66 of 182 patients (36%) had a recurrence during follow-up. This was not significantly different between groups. Using an intention-to-treat analysis, 124 patients (52%) had a recurrence. The recurrence rate was lowest in the RMN group. CONCLUSION: The use of CF sensing catheters did not improve procedural outcome or safety profile in comparison to non-CF sensing ablation in this observational study of ventricular arrhythmia ablations.
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BACKGROUND: Although catheter ablation (CA) is an accepted therapeutic option for atrial fibrillation (AF), data is lacking concerning the long-term thromboembolic event (TE) and mortality rate of patients after unsuccessful CA for AF. OBJECTIVE: The aim of the current study was to detect the long-term TE and mortality rate of patients with successful CA (group A) of AF and compared those with unsuccessful ablation (group B). METHODS: Following a 4-years of follow-up (FU) 330 patients were included into the groupA, and 105 patients into the group B. Primary outcome was defined as all stroke/TIA occurrence. Secondary outcome was considered as all-cause mortality and stroke - and TIA only occurrence. RESULTS: Seventeen patients developed a stroke/TIA during a median of 5.8 [5.1-7.3] years of FU. In the group A 8 (2.4%) patients developed a stroke/TIA during a FU of 2037 person-years (incidence rate 3.92 per 1000 person-years), compared to 9 patients in the group B during a FU of 726 person-years (incidence rate 12.4 per 1000 person-years). The crude HR for primary outcome was 2.84 (95% CI 1.078-7.48) in the group B compared with the group A. Cumulative TIA-alone incidence (3.97, CI 1.10-14.34, p=0.035) and the annualized TIA-alone incidence rate was significantly higher in the group B. (p=0.029). Neither the mortality rate nor the incidence rate of stroke-alone differed significantly among the groups. CONCLUSIONS: The risk of all stroke/TIA and TIA-alone is higher among patients after unsuccessful CA of AF compared to those after successful ablation.
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INTRODUCTION: Remote magnetic navigation (RMN)-guided catheter ablation (CA) is a feasible treatment option for patients presenting with ischemic ventricular tachycardia (VT). Catheter-tissue contact feedback, enhances lesion formation and may consequently improve CA outcomes. Until recently, contact feedback was unavailable for RMN-guided CA. The novel e-Contact Module (ECM) was developed to continuously monitor and ensure catheter-tissue contact during RMN-guided CA. OBJECTIVE: The present study aims to evaluate the effect of ECM implementation on acute and long-term outcomes in RMN-guided ischemic VT ablation. METHOD: This retrospective, two-center study included consecutive ischemic VT patients undergoing RMN-guided CA from 2010 to 2017. Baseline clinical data, procedural data, including radiation times, and acute success rates were compared between CA procedures performed with ECM (ECM+) and without ECM (ECM-). One-year VT-free survival was analyzed using Cox-proportional hazards models, adjusting for potential confounders: age, left ventricular function, VT inducibility at baseline and substrate based ablation strategy. RESULTS: The current study included 145 patients (ECM+ N = 25, ECM- N = 120). Significantly lower fluoroscopy times were observed in the ECM+ group (9.5 (IQR 5.3-13.5) versus 12.5 min (IQR 8.0-18.0), P = 0.025). Non-inducibility of the clinical VT at the end of procedure was observed in 92% ECM+ versus 72% ECM- patients (P = 0.19). ECM guidance was associated with significantly lower VT-recurrence rates during 1-year follow-up (16% ECM+ versus 40% ECM-; multivariable HR 0.29, 95%-CI 0.10-0.69, P = 0.021, reference group: ECM-). CONCLUSION: Contact feedback by the ECM further decreases fluoroscopy exposure and improves VT-free survival in RMN-guided ischemic VT ablation.