Magnetic solution to cardiac arrhythmia

Royal Brompton Hospital is steering the way with remote magnetic navigation to deliver impressive results for patients with cardiac arrhythmia.

Millions of people suffer from a potentially fatal irregular heartbeat, which is often caused by problems with the heart’s electrical system. In some cases medication to control the problem is ineffective and conventional techniques are not suitable.

Dr Sabine Ernst at Royal Brompton Hospital is the lead on this pioneering procedure, involving two giant magnets steered by a joystick to help treat these patients with faulty heart rhythms.

It operates on low power magnetic fields that ‘steer’ a very soft magnetically equipped ablation catheter. Due to its flexibility, the magnetic ablation catheter can reach sites that are difficult to access or are completely inaccessible using conventional techniques.

The team then burn small areas of the heart tissue, interrupting the faulty electrical signals that cause the irregular heartbeat. The treatment takes half the time of traditional manual procedures, and is producing impressive results.

A number of physicians both from the UK and abroad have travelled to Royal Brompton Hospital in order to be trained how to use the system.

The main advantages are increased clinical success and decreased risks of peri-procedural complications. One of the most easily measurable outcomes is the overall significant reduction in the use of radiation (x-rays).

In a case of a pregnant woman with a severe heart condition and permanent tachycardia, no x-rays at all were used and her tachycardia was successfully ablated using the magnetic navigation. The patient’s heart function improved significantly after the ablation, allowing her to go to full term with her pregnancy and delivering a healthy baby boy.

Procedure at a glance: Remote magnetic navigation

What problems does it solve? Whenever ablation of a cardiac arrhythmia is recommended, the option of magnetic navigation will be considered

because it leads to significant reduction in exposure to x-rays. Specifically, patients with the following arrhythmias can be treated:

• accessory pathways (Wolff-Parkinson-White syndrome)
• AV nodal reentrant tachycardia
• atrial tachycardia
• atrial fibrillation
• ventricular tachycardia

In particular, patients with congenital heart disease, complex anatomy and arrhythmias are benefitting from these advances and form a major emphasis in Dr Ernst’s clinical work.

How does it work? A small outer magnetic field (0.08 Tesla) is applied to the chest area of the patient that is steerable via a computer workstation. By changing the 3D direction of this field, small magnets inside the catheter have to align in parallel to the outer field. The forward and backward movement is performed via a motor drive.

Magnetic navigation is performed via a workstation that specifically enhances the integration of pre-acquired images from cardiac magnetic resonance (CMR) or computer tomography (CT) scans. Since the ablation catheter is very flexible (it lacks the normally required pullwires) it can take bends and curves very easily. The softness makes it particularly safe and unlikely to perforate the heart wall.

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