Catheter Ablation of Idiopathic Premature Ventricular Contractions Using Robotic Magnetic Navigation: Extensive Experience and Review

AIMS: This retrospective analysis of our extensive experience focuses on idiopathic premature ventricular contractions (PVC) ablation guided by robotic magnetic navigation (RMN). Critical evaluation is given to the causes and impact of acute procedural failure. METHODS: This retrospective cohort study enrolled 824 patients (mean PVC burden 21.0 ± 6.6%) undergoing first-time RMN-guided PVC ablation. Acute failure was defined as recurrent clinical PVC during the observation period after the last radiofrequency (RF) application. The Navigation Index was calculated as the ratio of RF delivery time to total ablation time. Multivariate logistic regression was used to detect the impact factors of acute failure from patient demographics, PVC characteristics, and procedural parameters. RESULTS: The mean procedure and fluoroscopic times were 73.8 ± 38.3 and 2.6 ± 2.9 min, respectively. The overall acute procedural failure rate was 11% (90/824). Acute procedure failure was strongly dependent on the PVC origin: lowest in the right ventricular outflow tract (2.7%) and highest in the left ventricular summit (44%). The primary mechanisms were determined to be intramural origins (50%, 45/90) and proximity to high-risk structures (24%, 22/90). Multivariate analysis identified PVC origin and Navigation Index (OR = 0.1, 95% CI 0.05-0.20; p < 0.001) as independent predictors of failure. A higher Navigation Index, reflecting greater procedural efficiency, correlated with procedural success. No major complications occurred, and minor complications were observed in 0.6% of patients. CONCLUSIONS: RMN-guided idiopathic PVC ablation demonstrated excellent safety and a relatively low acute procedural failure rate. Procedural outcomes are critically determined by the anatomical origin of the PVC and the procedural efficiency measured by the Navigation Index.