A meta-analysis of manual versus remote magnetic
navigation for ventricular tachycardia ablation
Mohit K. Turagam
Luigi Di Biase
Received: 22 March 2017 /Accepted: 30 May 2017 /Published online: 17 June 2017
Springer Science+Business Media New York 2017
Background There are limited studies on the safety and effi-
cacy of remote magnetic navigation (RMN) versus manual
navigation (MAN) in ventricular tachycardia (VT) ablation.
Methods 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.
Results The analysis included seven studies (one randomized,
three prospective observational, and three retrospective) in-
cluding 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 com-
plications (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.
Conclusion 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.
Keywords Ventricular tachycardia
Remote magnetic navigation and manual
Catheter ablation is an established treatment strategy for drug-
refractory ventricular tachycardia (VT), electrical storm, and
recurrent ICD shocks . Catheter ablation by manual navi-
gation (MAN) is a complex procedure that requires significant
operator experience and is associated with prolonged radiation
exposure and procedure time [2, 3]. Remote magnetic naviga-
tion (RMN) has evolved as a promising technology to over-
come some of the limitations of MAN. Theoretically, RMN
can offer greater catheter stability, increased precision during
RF energy delivery, decrease radiation exposure, and improve
clinical outcomes. Some of these benefits of RMN have been
demonstrated by the initial feasibility studies [4–11].
However, the studies are limited by small sample size and
differences in VT etiology, age, and comorbid conditions.
* Dhanunjaya Lakkireddy
Division of Cardiovascular Medicine, University of Missouri
Hospital and Clinics, Columbia, MO, USA
Division of Cardiovascular Diseases, Cardiovascular Research
Institute, University of Kansas Hospital & Medical Center, 3901
Rainbow Boulevard, Kansas City, KS 6616, USA
University of Chicago Medicine, Pritzker School of Medicine,
Chicago, IL, USA
Massachusetts General Hospital, Boston, MA, USA
Texas Heart Institute, Houston, TX, USA
Albert Einstein College of Medicine, New York, NY, USA
Texas Cardiac Arrhythmia Institute at St. David’s Medical Center,
Austin, TX, USA
J Interv Card Electrophysiol (2017) 49:227–235