Endo-epicardial ablation of ventricular arrhythmias in the left ventricle with the Remote Magnetic Navigation System and the 3.5-mm open irrigated magnetic catheter: results from a large single-center case-control series.

BACKGROUND: Remote magnetic navigation (RMN) has been reported as a feasible and safe mapping and ablation system for treatment of ventricular arrhythmias (VAs). However, the reported success rates have been limited with the 4- and 8-mm catheter tips. OBJECTIVE: This study sought to report the results in a large series of consecutive patients undergoing radiofrequency (RF) catheter ablation of VAs using the RMN with the 3.5-mm magnetic open-irrigated-tip catheter (OIC). METHODS: A total of 110 consecutive patients with a clinical history of left VA were included in the study. In all cases, an OIC was utilized for mapping and ablation. When ablation with the RMN catheters failed, a manual OIC was used to eliminate the VA. Postablation pacing maneuvers and isoproterenol were used to verify the inducibility of the VAs. Outcomes were compared with those of a group of 92 consecutive patients undergoing manual ablation by the same operator. RESULTS: Mapping and ablation with the magnetic OIC were performed in all 110 patients with VA. Ischemic cardiomyopathy was present in 33 (30%), nonischemic in 14 (13%), and in 63 (57%) patients no structural heart disease was present. Endocardial mapping was performed in all patients, whereas both endocardial and epicardial mapping were performed in 36 (33%) patients. Compared with manual ablation, RMN was associated with a longer procedural time (2.9 +/- 1.2 hours vs. 3.3 +/- 1.1 hours, P = 0.004) and RF time (24 +/- 12 minutes vs. 33 +/- 18 minutes, P = 0.005), whereas fluoroscopic time was significantly shorter (35 +/- 22 minutes vs. 26 +/- 14 minutes, P = 0.033). During the procedures, crossover to manual ablation was required in 15 patients (14%). At 11.7 +/- 2.1 months of follow-up in the study group and 18.7 +/- 3.7 months in the manual ablation group, 85% and 86% (P = 0.817) of patients, respectively, were free of VA. CONCLUSION: This large series of consecutive patients demonstrates that OIC ablation using RMN is effective for the treatment of left VAs.

Amiloidosis cardiaca / Cardiac amyloidosis

La amiloidosis cardiaca es una manifestación de un grupo de enfermedades sistémicas que en conjunto se conocen como amiloidosis. Se considera una causa importante de las enfermedades infiltrativas que pueden ser responsables tanto del compromiso cardiaco como de otros órganos. Dado el avance en el entendimiento de la fisiopatología de la enfermedad, el reconocimiento de sus causas primarias y secundarias, y de las nuevas opciones terapéuticas, se describe un caso típico del compromiso cardiaco y posteriormente se hace una revisión del tema que abarca la mayoría de los tópicos que guardan relación con la amiloidosis primaria con compromiso cardiaco.

Cardiac amyloidosis is a manifestation of a group of systemic diseases, known as amyloidosis. It is considered an important cause of infiltrative diseases that may be responsible for both the heart and other organs’ involvement. Given the progress in the understanding of the pathophysiology of the disease, the recognition of its primary and secondary causes and the new therapeutic options, a typical case of cardiac involvement is described and a review of the subject that covers the great majority of topics related to primary amyloidosis with cardiac involvement is made.