Catheter ablation of premature ventricular contractions using an Alternative vascular access and Remote Magnetic navigation (ARM) approach

Abstract Background Catheter ablation of premature ventricular contractions (PVC) is a routine procedure carried in patients with high PVC burden achieving high success rates of complete elimination in follow-up. So far, these procedures have been carried out via a femoral approach. We recently suggested an alternative access for invasive ablation procedures via the upper limb vasculature using remote magnetic navigation. Purpose We investigated if a single catheter ablation procedure using an ARM approach is safe and feasible in patients with high PVC burden and therefore indication for curatively intended ablation procedure. Methods Eight consecutive patients (4 female, mean age 49 years) awaiting catheter ablation for premature ventricular contractions (PVCs) underwent 9 invasive EP studies using the ARM approach. Patients had a structurally normal heart (n=5), dilated cardiomyopathy (n=1) or congenital heart disease (n=2). Vascular access was obtained under ultrasound guidance and a single magnetic ablation catheter (Navistar RMT irrigated tip [8F, n=8] or MagnoFlush [7F, n=1]) was advanced into the right ventricle from the left brachial (n=5), left basilic (n=2) or right basilic vein (n=2). In 4 patients, radial (n=3) or brachial (n=1) arterial access was obtained in addition to allow retrograde access to the aortic root and left ventricle. In 8 procedures, the 3D non-invasive mapping system VIVO (Catheter Precision) was used to locate the PVC origin whilst the patient was still on the ward to identify the ablation target region before the procedure. Results PVC site of origin was identified in the right ventricular outflow tract in all patients. Pace mapping was used in addition to earliest local bipolar activation and qs signals on unipolar recordings. A median of 7.4 (4.6 – 10.1) minutes of radiofrequency (50-70 Watts, 30 ml flow, up to 30 sec) was applied to eliminate the PVC. Median procedure duration amounted to 102 (80 – 107) minutes with a median fluoroscopy duration of 23 (11 – 26) seconds and a radiation dose of 3.9 (3.4 – 7.9) cGycm2. There were no acute complications besides moderate bruising at the puncture sites which all resolved without sequelae. During the follow-up, a significant reduction of the individual PVC burden was observed (Figure 1). Patient feedback and time to full recovery was investigated. Conclusion Catheter ablation of PVCs using an ARM approach and a single ablation catheter is feasible, safe and effective. Initial feedback from patients is overwhelmingly positive. No conversion to a femoral approach was necessary and no bed rest was required.Figure 1