Letter from the Editor in Chief

DOI: 10.19102/icrm.2016.070308

MOUSSA MANSOUR, MD, FHRS, FACC

Editor-in-Chief

Dear Readers,

In the February issue of the Journal, I highlighted an article discussing the value of electrophysiology study for risk assessment of sudden cardiac death in patients with congenital heart disease. Today, I would like to highlight another article describing the role of remote magnetic navigation for catheter ablation, also in patients with congenital heart disease. As I mentioned last month, significant progress has been achieved in the treatment of children born with heart defects. Most of these patients now reach adulthood with a relatively uneventful course. As they get older, they can develop late complications of their operations with arrhythmias being the most common cause of morbidity and mortality.

The article by Samples et al. describes the use of remote magnetic navigation to guide catheter ablation of atrioventricular nodal reentrant tachycardia in an adult patient with prior surgical closure of perimembranous ventricular septal defect during infancy. The case report is important because it stresses the value of remote magnetic navigation in this patient population. These patients often have complex anatomies causing difficulties in accessing the area of interest and maintaining a stable catheter position. Over the past few years a number of studies from EP laboratories in the US and Europe have described the usefulness of remote catheter navigation in overcoming some of these challenges. One particular area where this system can be useful is facilitating retrograde aortic access and mapping, and avoiding transseptal puncture which can be challenging in some of these patients. The ability to steer the magnetic ablation catheter via the distal end allows the access of most sites within a given cardiac chamber despite the difficult anatomy.

One disadvantage of the system is the cost and the need of specialized infrastructure including shielding of the procedure room. Hopefully future generation of the system will be easier to install and less costly.

Best wishes for a happy spring and I hope you enjoy reading this issue of the Journal.

Regards,

Editor-in-Chief

Moussa Mansour, MD, FHRS, FACC
Editor-in-Chief
The Journal of Innovations in Cardiac Rhythm Management
MMansour@InnovationsInCRM.com
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital Boston, MA