Remote magnetic-guided catheter ablation versus manual ablation in patients with repaired congenital heart disease and atrial tachyarrhythmias: propensity-matched observational study of long-term results

Abstract

Aim. To compare the long-term outcomes of the catheter ablation (CA) using remote magnetic-guided navigation (RMN) and manual radiofrequency CA (MAN) in patients with congenital heart defect (CHD) and incisional atrial tachyarrhythmias (AT). Methods. In this retrospective study cohort, 67 patients were included with CHD and AT. CHD were classified based on complexity (simple, moderate, and complex) according to ACC/AHA guidelines 2008. Fifty-seven (85%) patients underwent at least one surgical procedure for CHD correction before CA. The patients were divided into the two groups regarding CA approach: the MAN group (n=42) and the RMN group (n=25). The primary endpoitnts was long-term freedom from any AT, including atrial fibrillation. Key secondary endpoints included perioperative and late complications. To compare freedom from any AT between the groups, 1:3 propensity score matching was applied, and 63 patients were matched. The matching was exact on CHD complexity. The weighted matched observations were assessed with univariate Cox regression with any AT as the outcome. Results. The median follow-up period was 20 months. In the matched MAN and RMN groups, 92.3% and 83.3% patients, respectively, had incisional АТ (p=0.27), the other patients having additionally AF. The mean fluoroscopy time was statistically significant lower in the RMN group compared with MAN (р=0.009) with longer procedural duration in the RMN group (p<0.001). There was no statistically significant difference in perioperative and late complications. The freedom from any AT 36 months after CA was 78.9% in the matched RMN group and 47.2% in the matched MAN group. The comparison of freedom from any AT between the groups yielded p=0.040, hazard ration 0.32 [95% confidence interval 0.11; 0.95]. Conclusion. RMN CA was superior over manual CA with respect to long-term freedom from AT in patients with CHD with similar safety profile.