Feasibility and outcomes of catheter ablation using robotic magnetic navigation in patients with congenital heart disease with varying defect complexity

Introduction Robotic magnetic navigation (RMN) allows for catheter ablation in the presence of complex cardiac anatomy, such as that seen in congenital heart disease (CHD). The objective of this study was to evaluate the feasibility, efficacy and safety of this procedure in a wide range of CHD conditions. Methods Patients with CHD who underwent catheter ablation for cardiac arrhythmias using RMN were included in this single-centre observational study. Patients’ baseline characteristics, procedural data, periprocedural complications and acute success rates were obtained. The efficacy of the ablation was evaluated during follow-up in the outpatient clinic using 24-h Holter monitoring. Results The study population consisted of 38 patients (26 males) with a median age of 36.8 (IQR 30.8-39.6) years. Surgically corrected transposition of the great arteries was the most common CHD, observed in 14 patients (36.8%). Nineteen patients (50.0%) had more than one congenital defect. Intra-atrial re-entrant tachycardia was the most common arrhythmia ablated, accounting for 21 procedures (55.3%). Median procedural time was 232.5 min (IQR 186.3-281.3); the median radiation dose and radiation time were 2.4 mGy m 2 (IQR 1.3-4.4) and 14.0 min (IQR 9.5-30.4), respectively. Acute arrhythmia cessation was observed in 81.6% of procedures. Major complications were noted in 2 cases (5.3%). The median time from the ablation to follow-up was 5.4 months (IQR 3.4-9.3). Arrhythmia recurrence was observed in 7 cases (18.4%). Conclusions RMN is a valuable tool for catheter ablation of arrhythmias in patients with congenital heart disease and complex anatomy.