Background 

Catheter ablation is a safe and effective treatment option for ventricular arrhythmias (VAs). Remote Magnetic Navigation (RMN) facilitates cardiac mapping and ablation. This study aimed to evaluate the long-term efficacy of ablation procedures for ventricular tachycardia (VT) and premature ventricular contractions (PVC) and to identify independent predictors (IP) for arrhythmia recurrence after RMN-guided ablation.

Methods

A total of 176 consecutive patients (mean age 53.23 ± 17.55 years, 37% female) underwent RMN-guided VA ablation for recurrent episodes of symptomatic VTs and/ or PVC. 132 patients (75%) suffered from symptomatic PVC and 43 (24%) from recurrent VTs. The cohort consisted of 119 patients (68%) with idiopathic VTs, 31 patients (18%) with ischemic (ICM) and 26 patients (15%) with dilated cardiomyopathy (DCM). Primary endpoint was freedom from any VA recurrence during long-term follow-up.

Results

VA recurrence was observed in 69 patients (39%; mean age 51.71 ± 19.91 years, 23 % female) during a follow-up period of >5 years. Patients who underwent RMN-guided VT ablation had a significantly higher risk for recurrence (p=0.009*) compared to those with PVC. DCM was associated with a significantly higher risk for VA recurrence compared to ICM (p=0.002*). In addition, multivariate analyses found DCM to be an IP for VA recurrence (p<0.001*, hazard ratio (HR) 5.78, confidence interval (CI) 3.05-10.95) with a 5.8-fold increase for recurrence. ICM resulted in a 56% increase in VA recurrence (p=0.200, HR 1.56, CI 0.74-3.25), too. Heart failure with an impaired LVEF < 40% was also identified as IP for recurrence (p= 0.004*, HR 2.06, CI 1.26-3.35). 16 patients (9%) di

ed within the observational period, 12 of them (75%) underwent initial RMN-guided VT ablation. 

Conclusions

RMN for treatment of VAs is safe and effective in experienced centers and leads to acceptable long-term results in terms of arrhythmia recurrence. An impaired LV function (LVEF < 40%) was identified as IP for VA recurrence. Patients with DCM had a significantly higher risk for VA recurrence compared to other cardiomyopathies. Thus, personalized paths in VA management are needed to improve efficacy and outcome.