Remote-controlled magnetic ablation of a right anterolateral accessory pathway—The superior caval vein approach

Julian Kyoung-Ryul Chun1, Boris Schmidt1, Karl-Heinz Kuck1, Sabine Ernst1
1II. Medical Department, St. Georg General Hospital, Hamburg, Germany

Tóm tắt

An 18-year old male patient with recurrent supraventricular tachycardias was admitted for catheter ablation. Baseline ECG was consistent with right anterolateral accessory pathway (AP) conduction. The novel magnetic navigation system (MNS, Niobe Stereotaxis) in combination with a catheter advancer unit (Cardiodrive, Stereotaxis) allows a complete remote-controlled electrophysiologic study and ablation. Despite accurate identification of the AP insertion site using the MNS, a stable catheter position was not achieved from the inferior caval vein. Therefore, the venous access was switched to the superior caval vein approach using the left subclavian vein. The same magnetic field vector now resulted in a perfectly stable catheter position, and application of radiofrequency current immediately blocked AP conduction. This case demonstrates feasibility and safety of a complete remote-controlled ablation of a right-sided anterolateral accessory pathway using the superior approach in conjunction with the novel magnetic navigation system Niobe.

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Tài liệu tham khảo

Jackman, W. M., Wang, X. Z., Friday, K. J., Roman, C. A., Moulton, K. P., Beckman, K. J., et al. (1991). Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White syndrome) by radiofrequency current. New England Journal of Medicine, 324, 1605–1611.

Kuck, K. H., Schluter, M., Geiger, M., Siebels, J., & Duckeck, W. (1991). Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet, 337, 1557–1561.

Faddis, M. N., Blume, W., Finney, J., Hall, A., Rauch, J., Sell, J., et al., magnetically guided catheter for endocardial mapping and radiofrequency catheter ablation. (2002). Circulation, 106, 2980–2985.

Faddis, M. N., Chen, J., Osborn, J., Talcott, M., Cain, M. E., & Lindsay, B. D. (2003). Magnetic guidance system for cardiac electrophysiology: A prospective trial of safety and efficacy in humans. Journal of the American College of Cardiology, 42, 1952–1958.

Ernst, S., Hachiya, H., Chun, J., & Ouyang, F. (2005). Remote catheter ablation of parahisian accessory pathways using a novel magnetic navigation system—A report of two cases. Journal of Cardiovascular Electrophysiology, 1–4.

Ernst, S., Ouyang, F., Linder, C., Hertting, K., Stahl, F., Chun, J., et al. (2004). Experience with remote catheter ablation using a novel magnetic navigation system: Magnetic remote catheter ablation. Circulation, 12, 1472–1475.

Chun, K. R. J., Ernst, S., Matthew, S., Bänsch, D., Ouyang, F., Antz, M., et al. (2004). First accessory pathway ablation using complete remote controlled magnetic catheter navigation in humans. Circulation, 2167, 110, 17 (suppl. III).

Ernst, S., Ouyang, F., Linder, C., Hertting, K., Stahl, F., Chun, J., et al. (2004). Modulation of the slow pathway in the presence of a persistent left superior caval vein using the novel magnetic navigation system Niobe. Europace, 1, 10–14.

Morady, F., Strickberger, A., Man, K. C., Daoud, E., Niebauer, M., Goyal, R., et al. (1996). Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways. Journal of the American College of Cardiology, 27, 683–689.

Ernst, S., Ouyang, F., Antz, M., Cappato, R., & Kuck, K. H. (2000) Catheter ablation of atrioventricular reentry. In D. P. Zipes & J. Jalife (Eds.), Cardiac electrophysiology: From cell to bedside Third Edition (pp. 771–781). Philadelphia: Saunders.

Thornton, A. S., Alings, M., Scholten, M. F., & Jordaens, L. J. (2005). Left ventricular lead placement within a coronary sinus side branch, using only a floppy guide wire and magnetic navigation. Heart, 91, 22.