Vol. 26 No. 2 (2022)
CASE REPORTS

The first experience of using robotic magnetic navigation for interventional treatment of post-incisional atrial flutter in patients with congenital heart defects after surgical correction: case series

A.B. Romanov
Meshalkin National Medical Research Center, Novosibirsk
A.G. Filippenko
Meshalkin National Medical Research Center, Novosibirsk
V.V. Beloborodov
Meshalkin National Medical Research Center, Novosibirsk
Bio
I.L. Mikheenko
Meshalkin National Medical Research Center, Novosibirsk
V.V. Shabanov
Meshalkin National Medical Research Center, Novosibirsk
Аблация инцизионного трепетания предсердий (2 цикла) с помощью роботизированной магнитной навигации

Published 2022-06-30

Keywords

  • arrhythmia,
  • atrial flutter,
  • case series,
  • congenital heart disease,
  • robotic magnetic navigation

How to Cite

Romanov, A., Filippenko, A., Beloborodov, V., Mikheenko, I., & Shabanov, V. (2022). The first experience of using robotic magnetic navigation for interventional treatment of post-incisional atrial flutter in patients with congenital heart defects after surgical correction: case series. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 26(2), 66–72. https://doi.org/10.21688/1681-3472-2022-2-66-72

Abstract

Post-incisional heart rhythm disturbances are one of the most frequent complications after open cardiac surgery. Lession in the atrial myocardium create conditions for slowing impulse conduction, formation and circulation of reentry. Case series included 8 patients after correction of complex congenital heart disease (CHD) with post-incisional atrial flutter (AF), despite treatment with antiarrhythmic drugs. All patients underwent interventional AF treatment using the robotic magnetic navigation (RMN) system. Perioperative complications, duration of surgery, time of fluoroscopy and efficacy (free of atrial tachyarrhythmias 3 months after the ablation procedure) of treatment were assessed during a follow-up period of 12 months.

The article presents a series of clinical cases of RMN application for the treatment of post-incisional AF in patients with CHD after open cardiac surgery. The first Russian experience of using RMN for the treatment of post-incisional AF in patients with CHD after open cardiac surgery demonstrated safety and high efficiency both in the early and long-term follow-up periods. More experience and multicenter studies in a large cohort of patients are needed to determine the role of RMN as the first line of therapy for performing catheter ablation in this category of patients.

Received 12 November 2021. Accepted 6 December 2021.

Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.

Funding: The work is supported by a grant of the President of the Russian Federation No. МД-1997.2020.7

Conflict of interest: Authors declare no conflict of interest.

Contribution of the authors
Literature review: V.V. Beloborodov, A.G. Filippenko
Drafting the article: A.B. Romanov, V.V. Beloborodov, A.G. Filippenko
Critical revision of the article: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, V.V. Shabanov
Surgical treatment: A.B. Romanov, V.V. Shabanov
Final approval of the version to be published: A.B. Romanov, A.G. Filippenko, V.V. Beloborodov, I.L. Mikheenko, V.V. Shabanov

References

  1. Kalman J.M., VanHare G.F., Olgin J.E., Saxon L.A., Stark S.I., Lesh M.D. Ablation of ‘incisional’ reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation. 1996;93(3):502-512. PMID: 8565168. https://doi.org/10.1161/01.cir.93.3.502
  2. Leonelli F.M., Tomassoni G., Richey M., Natale A. Ablation of incisional atrial tachycardias using a three-dimensional nonfluoroscopic mapping system. Pacing Clin Electrophysiol. 2001;24(11):1653-1659. PMID: 11816635. https://doi.org/10.1046/j.1460-9592.2001.01653.x
  3. Liu X.-Y., Jacobsen P.K., Pehrson S., Chen X. Catheter ablation of incisional atrial tachycardia using remote magnetic navigation in patients after heart surgery: comparison between acquired and congenital heart disease. Europace. 2018;20(suppl 2):ii33-ii39. PMID: 29722858. https://doi.org/10.1093/europace/euy005
  4. Saoudi N., Cosío F., Waldo A., Chen S.A., Iesaka Y., Lesh M., Saksena S., Salerno J., Schoels W., Working Group of Arrhythmias of the European of Cardiology and the North American Society of Pacing and Electrophysiology. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases: a Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22(14):1162-1182. PMID: 11440490. https://doi.org/10.1053/euhj.2001.2658
  5. Garson A. Jr, Bink-Boelkens M., Hesslein P.S., Hordof A.J., Keane J.F., Neches W.H., Porter C.J. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol. 1985;6(4):871-878. PMID: 4031302. https://doi.org/10.1016/s0735-1097(85)80497-6
  6. Akca F., Bauernfeind T., Witsenburg M., Dabiri Abkenari L., Cuypers J.A., Roos-Hesselink J.W., de Groot N.M., Jordaens L., Szili-Torok T. Acute and long-term outcomes of catheter ablation using remote magnetic navigation in patients with congenital heart disease. Am J Cardiol. 2012;110(3):409-414. PMID: 22572608. https://doi.org/10.1016/j.amjcard.2012.03.040
  7. Roy K., Gomez-Pulido F., Ernst S. Remote magnetic navigation for catheter ablation in patients with congenital heart disease: a review. J Cardiovasc Electrophysiol. 2016;27(Suppl 1):S45-S56. PMID: 26969223. https://doi.org/10.1111/jce.12903
  8. Wu J., Pflaumer A., Deisenhofer I., Ücer E., Hess J., Zrenner B., Hessling G. Mapping of intraatrial reentrant tachycardias by remote magnetic navigation in patients with d-transposition of the great arteries after Mustard or Senning procedure. J Cardiovasc Electrophysiol. 2008;19(11):1153-1159. PMID: 18631275. https://doi.org/10.1111/j.1540-8167.2008.01231.x
  9. Romanov A., Filippenko A., Elesin D., Losik D., Grishkov A., Shabanov V. Remote magnetic navigation ablation via the right jugular vein approach in patient with interruption of the inferior vena cava and incessant left atrial flutter. Pacing Clin Electrophysiol. 2021;44(2):385-388. PMID: 32969523. https://doi.org/10.1111/pace.14078
  10. Ernst S. Robotic approach to catheter ablation. Curr Opin Cardiol. 2008;23(1):28-31. PMID: 18281824. https://doi.org/10.1097/HCO.0b013e3282f2c95c
  11. Белобородов В.В., Елемесов Н.А., Пономаренко А.В., Моржанаев Е.А., Филиппенко А.Г., Михеенко И.Л., Чернявский А.М., Романов А.Б. Роботизированная магнитная навигация при лечении сложных нарушений ритма сердца у пациентов после хирургической коррекции врожденных пороков сердца. Патология кровообращения и кардиохирургия. 2021;25(1):32-39. https://dx.doi.org/10.21688/1681-3472-2021-1-32-39 Beloborodov V.V., Elemesov N.A., Ponomarenko A.V., Morzhanaev E.A., Filippenko A.G., Mikheenko I.L., Chernyavskiy A.M., Romanov A.B. Remote magnetic navigation for heart rhythm disturbances treatment in patients after surgical correction of congenital heart disease. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2021;25(1):32-39. (In Russ.) https://dx.doi.org/10.21688/1681-3472-2021-1-32-39
  12. Ардашев В.Н., Ардашев А.В., Желяков Е.Г., Шаваров А.А., Рыбаченко М.С., Кощеева Л.А. Первый отечественный опыт радиочастотной катетерной абляции с помощью роботизированной системы магнитной навигации по поводу нарушений ритма сердца. Кардиология. 2007;47(9):56-61. Ardashev V.N., Ardashev A.V., Zhelyakov E.G., Shavarov A.A., Rybatchenko M.S., Koshcheeva L.A. First in Russia experience of radiofrequency ablation with the help of robotic system of magnetic navigation on the occasion of heart rhythm disturbance. Kardiologiia = Cardiology. 2007;47(9):56-61. (In Russ.)
  13. Schwagten B., Jordaens L., Witsenburg M., Duplessis F., Thornton A., van Belle Y., Szili-Torok T. Initial experience with catheter ablation using remote magnetic navigation in adults with complex congenital heart disease and in small children. Pacing Clin Electrophysiol. 2009;32(Suppl 1):S198-S201. PMID: 19250093. https://doi.org/10.1111/j.1540-8159.2008.02283.x
  14. Ueda A., Suman-Horduna I., Mantziari L., Gujic M., Marchese P., Ho S.Y., Babu-Narayan S.V., Ernst S. Contemporary outcomes of supraventricular tachycardia ablation in congenital heart disease: a single-center experience in 116 patients. Circ Arrhythm Electrophysiol. 2013;6(3):606-613. PMID: 23685536. https://doi.org/10.1161/CIRCEP.113.000415
  15. Suman-Horduna I., Babu-Narayan S.V., Ueda A., Mantziari L., Gujic M., Marchese P., Dimopoulos K., Gatzoulis M.A., Rigby M.L., Ho S.Y., Ernst S. Magnetic navigation in adults with atrial isomerism (heterotaxy syndrome) and supraventricular arrhythmias. Europace. 2013;15(6):877-885. PMID: 23355132. https://doi.org/10.1093/europace/eus384