Emerging treatments
Remote magnetic navigation
Remote magnetic navigation (RMN) is a robotic navigation technique used in the mapping and ablation of arrhythmias. It is associated with better catheter precision and stability than with a manual technique. One systematic review found RMN to be an effective and safe method for the ablation of ventricular tachycardia with low recurrence and complication rates; however, the quality of the reviewed evidence was poor.[57] One small retrospective study in children found that RMN-guided ablation was associated with lower ventricular arrhythmia recurrence rates and allowed for lower fluoroscopy doses than with manual-guided ablation.[58] However, one longer-term study in adults found that ventricular arrhythmia recurred within 5.5 years in 39% of 176 individuals who underwent RMN-guided ablation.[59] Risk of recurrence was greatest in those with left ventricular ejection fraction <40%, dilated cardiomyopathy, and those receiving antiarrhythmic pharmacotherapy.[59] Clinical studies of RMN in ventricular arrhythmia and atrial fibrillation are ongoing.
Stereotactic radioablation
Stereotactic body radiation therapy, or stereotactic radioablation, is an emerging modality for the treatment of ventricular arrhythmias that are refractory to antiarrhythmic therapy and catheter ablation. It involves the precise delivery of a very high radiation dose to the targeted area, while minimizing collateral damage to the surrounding myocardium and other structures. The ENCORE-VT trial was a prospective phase 1/2 trial on noninvasive cardiac radioablation in treatment-refractory VT. Nineteen patients were included in the study, and stereotactic radioablation was associated with reduced ventricular arrhythmia burden with modest short-term risks, reduction in antiarrhythmic therapy, and improvement in quality of life.[60]
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