Magnetic Versus Manual Catheter Navigation for Ablation of Ventricular Tachycardia: A Systemic Review and Meta-Analysis
Ablation of Ventricular Tachycardia
Background: This study was conducted to evaluate the efficacy, and procedural complications of remote magnetic navigation (RMN) versus manual catheter navigation (MCN) for ablation of ventricular tachycardia.Subjects and Methods:We performed electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through April 6, 2017, to identify clinical trials comparing RMN with MCN. The primary efficacy outcomes were acute failed ablation and recurrent VT rates. Secondary outcomes in our study were procedural time, fluoroscopic time and procedural complications.Results:Six clinical trials, including a total of 582 patients, were identified, of which 324 underwent RMN guided VT ablation, and 258 underwent MCN guided VT ablation. Acute procedural success (or reduced failed VT ablation rates) was significantly improved with RMN group versus MCN group (10% versus 19% respectively, RR 0.56; 95% CI 0.38 – 0.83) with no statistically significant difference in the recurrent VT rates (RR 0.87, 95% CI 0.64-1.19). The total procedure time was not significantly different between the two groups. However, the total fluoroscopy time (Standard mean difference -1.00, 95% CI -1.32 - -0.67; p<0.001) was significantly lower and a trend towards reduced procedural complications (RR 0.40, 95% CI 0.16 – 0.99; p=0.05) was observed in the RMN group versus MCN group, respectively.Conclusion: In this meta-analysis, there was a significant benefit regarding acute VT ablation success rate and a significant reduction in radiation exposure, with a trend towards reduction in procedure-related complication in patients undergoing RMN guided VT ablation versus MCN VT ablation approach.