A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation

Mohit K. Turagam, Donita Atkins, Roderick Tung, Moussa Mansour, Jeremy Ruskin, Jie Cheng, Luigi Di Biase, Andrea Natale, Dhanunjaya Lakkireddy

There are limited studies on the safety and efficacy of remote magnetic navigation (RMN) versus manual navigation (MAN) in ventricular tachycardia (VT) ablation. A comprehensive literature search was performed using the keywords VT ablation, stereotaxis, RMN and MAN in Pubmed, Ebsco, Web of Science, Cochrane, and Google scholar databases. The analysis included seven studies (one randomized, three prospective observational, and three retrospective) including 779 patients [both structural heart disease (SHD) and idiopathic VT] comparing RMN (N = 433) and MAN (N = 339) in VT ablation. The primary end point of long-term VT recurrence was significantly lower with RMN (OR 0.61, 95% CI 0.44-0.85, p = 0.003) compared with MAN. Other end points of acute procedural success (OR 2.13, 95% CI 1.40-3.23, p = 0.0004) was significantly higher with RMN compared with MAN. Fluoroscopy [mean difference -10.42, 95% CI -12.7 to -8.1, p < 0.0001], procedural time [mean difference -9.79, 95% CI -19.27 to -0.3, p = 0.04] and complications (OR 0.35, 95% CI 0.17-0.74, p = 0.0006) were also significantly lower in RMN when compared with MAN. In a subgroup analysis SHD, there was no significant difference in VT recurrence or acute procedural success with RMN vs. MAN. In idiopathic VT, RMN significantly increased acute procedural success with no difference in VT recurrence. The results demonstrate that RMN is safe and effective when compared with MAN in patients with both SHD and idiopathic VT undergoing catheter ablation. Further prospective studies are needed to further verify the safety and efficacy of RMN.