European Heart Journal Advance Access originally published online on November 24, 2007
European Heart Journal 2008 29(3):422; doi:10.1093/eurheartj/ehm541
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Remote ablation of accessory pathways
Department of Cardiology
Division of Electrophysiology and Cardiac Pacing Unit
San Raffaele Scientific Institute
Via Olgettina
60 20132 Milan
Italy
Tel: +39 02 26437310
Fax: +39 02 26437326
Email: carlo.pappone{at}hsr.it
Department of Cardiology Division of Electrophysiology and Cardiac Pacing Unit
San Raffaele Scientific Institute
Via Olgettina
60 20132 Milan
Italy
Tel: +39 02 26437347
Fax: +39 02 26437326
Email: vincenzo.santinelli{at}hsr.it
We read with interest, pleasure, and satisfaction the recent study by Chun et al.1 which definitively confirms our previous pivotal experience on the efficacy of remote ablation in hundreds of patients with single or multiple accessory pathways.2,3 However, in our experience, soft magnetic catheters (1 M, 3 M, or 3 M quadripolar) are all able to easily record the AP potential and once identified such important target, ablation of AP is successful in almost all patients regardless of the type of catheter.2–4 Obviously, it is easier to use 3 M quadripolar catheters particularly at the beginning of the learning curve but the success rate is similar as reported later by other authors.5 This pilot study by the St George Hospital group on few patients (18, 27, and 14 patients treated with 1 M, 3 M, and 3 M quadripolar catheters, respectively) in our opinion represents just a chronologic learning curve with remote ablation which gives a wrong message to the readers of the Journal, since the authors come to a conclusion that is exactly opposite to what is stated in the limitations. How can a limited non-randomized ‘chronological experience’, such as this, allow the authors to conclude that there is a ‘significantly improved efficacy of the procedure’ with the three-magnet quadripolar ablation catheter? This is not scientifically correct. Similarly, their pilot experience on AVNRT which reported a relatively low success rate with remote ablation again represents in our opinion the beginning of their learning curve with this novel system.6 Our previous extensive experience in hundreds of patients with AVNRT4 demonstrated that remote ablation is highly successful as in patients with AP suggesting that only when the operator is experienced with magnetic navigation and ablation, randomized studies are appropriate to demonstrate a potential difference between catheters. We again thank the authors for reproducing our firstly reported results on remote ablation of AP since reproducibility is considered essential for scientific progress.
References
- Chun JK, Ernst S, Matthews S, Schmidt B, Bansch D, Boczor S, Ujeyl A, Antz M, Ouyang F, Kuck KH. Remote-controlled catheter ablation of accessory pathways: results from the magnetic laboratory. Eur Heart J (2007) 28:190–195.
[Abstract/Free Full Text] - Pappone C, Sala S, Sora N, Vicedomini G, Ciaccio C, Sacchi S, Marzi A, Santinelli V. Direct recording of Kent bundle by magnetic catheter recording as guide for successful ablation of accessory pathways. Circulation (2005) 112:U633–U634.
- Pappone C, Vicedomini G, Sora N, Sala S, Frigoli E, Avitabile M, Stuto A, Augello G, Sacchi S, Marzi A, Santinelli V. Safety and efficacy of remote ablation by magnetic catheter in patients with WPW syndrome. J Am Coll Cardiol (2006) 47.
- Pappone C, Sora N, Sala S, Vicedomini G, Ciaccio C, Sacchi S, Marzi A, Santinelli V. Remote magnetic catheter mapping and ablation for node reentrant atrio-ventricular tachycardia. Circulation (2005) 112.
- Thornton AS, Janse P, Theuns DA, Scholten MF, Jordaens LJ. Magnetic navigation in AV nodal re-entrant tachycardia study: early results of ablation with one- and three-magnet catheters. Europace (2006) 8:225–230.
[Abstract/Free Full Text] - Ernst S, Ouyang F, Linder C, Hertting K, Stahl F, Chun J, Hachiya H, Bänsch D, Antz M, Kuck KH. Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation. Circulation (2004) 109:1472–1475.
[Abstract/Free Full Text]
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