Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large-scale single-center study

Background: Remote magnetic navigation (RMN)-guided ablation has become an inspiring method of catheter ablation for tachyarrhythmias.

Hypothesis: Data from a large-scale single center may provide further insight into the safety of and the learning curve for RMN-guided ablation.

Methods: A total of 1003 catheter ablation procedures using RMN for conditions including supraventricular ventricular tachycardia, atrial tachyarrhythmias, and premature ventricular contraction/ventricular tachycardia (PVC/VT) were retrospectively analyzed from an ablation registry. Procedural outcomes, including procedure time, mapping time, X-ray time, and RF time, were assessed. The complications were classified into two categories: major and minor. A subanalysis was used to illustrate the learning curve of RMN-guided ablation by assessing procedure time and total X-ray time of 502 atrial fibrillation (AF) ablation procedures.

Results: Among these procedures, 556 (55.4%) were AF and 290 (28.9%) were PVC/VT. Electrical pulmonary vein isolation was achieved in 99.0% of AF procedures, and acute success reached 90.3% in PVC/VT procedures. The overall complication rate was 0.5%. In the subanalysis of AF procedures, the overall procedure time and X-ray time of procedures were short (125.9 ± 54.6 and 5.3 ± 3.9 minutes, respectively) and proceeded to decrease from the initial 30 procedures to about 300 procedures, where the learning curve reached plateau, demonstrating maximum procedure efficiency.

Conclusions: RMN-guided ablation is safe, as verified by very low overall complication rate and reduced X-ray time. In our study, even the first AF procedures had a relatively low procedure time and total X-ray time, and procedure efficiency improved during the learning curve.