Interference of remote magnetic catheter navigation and ablation with implanted devices for pacing and defibrillation.

摘要

AIMS: Remote magnetic catheter navigation (RMN) may facilitate catheter ablation. However, as the system uses permanent magnets, interference (INF) with devices for pacing [pacemaker (PM)], defibrillation [implantable cardioverter defibrillators (ICD)], or cardiac resynchronisation [cardiac resynchronization therapy (CRT)] may occur. We investigated the effects of the RMN system on implanted arrhythmia devices in a prospective series. METHODS AND RESULTS: Prior to RMN-guided electrophysiological procedures, devices were fully interrogated and programmed to VVI 40/min with tachycardia detection off (if applicable). Periprocedural device performance was monitored by 12-lead electrocardiogram, and duration and effect of asynchronous stimulation resulting from INF were evaluated. Following the procedure, devices were again interrogated and system integrity verified. A total of 21 procedures in 18 patients with implanted devices [PM n = 12, ICD n = 3, CRT-pacemaker (P) n = 1, CRT-defibrillation (D) n = 2] were evaluated. No relevant changes in lead parameters or device programming were observed after the procedure. No INF was noted in ICD/CRT-D devices (tachycardia detection off) and in 2 PMs, whereas 10 PMs and 1 CRT-P switched to asynchronous stimulation for 1.8 +/- 0.3 h (63 +/- 13% of RMN duration) without clinical adverse effects. In one patient, ventricular tachycardia (VT) degenerating in ventricular fibrillation occurred, but no causal relation between INF and VT initiation could be ascertained. CONCLUSION: This prospective data provide no evidence that using RMN in patients with implanted arrhythmia devices may cause persistent device dysfunction. Asynchronous PM stimulation is common without negative clinical consequences. Although a causal role of INF for the VT observed seems unlikely, risks and benefits of RMN utilization should carefully be weighed for each patient with an implanted arrhythmia device.