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Robotic vs. Manual Ablation for Atrial Fibrillation | Journal Scan
Study Questions:
Does remote robotic navigation (RRN) improve outcomes after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?
Methods:
One hundred fifty-seven patients (mean age 59 years) referred for RFCA of AF (persistent in 74%) were randomly assigned to RRN (n = 79) or to conventional manual catheter navigation (n = 78). Patients underwent circumferential pulmonary vein isolation and patients with persistent AF also underwent left atrial ablation. The primary endpoint was single-procedure efficacy at 12 months.
Results:
There was no significant difference in the primary endpoint between the RRN group (24%) and manual group (33%), or in the rate of major complications (RRN 8.9%, manual 6.4%). The procedure time, fluoroscopy time, and radiation dose also did not differ significantly between the two groups. Multivariate analysis demonstrated that RRN was independently associated with shorter fluoroscopy times. The mean number of catheter displacements was significantly lower in the RRN group than in the manual group (one vs. five, respectively). Subjectively assessed operator fatigue was significantly lower in the RRN group.
Conclusions:
The authors concluded that RRN does not improve the efficacy of RFCA of AF, but does reduce fluoroscopy exposure, catheter displacements, and operator fatigue.
Perspective:
Although RRN was associated with shorter fluoroscopy times, the mean fluoroscopy time in the RRN group nevertheless was long (46 minutes) despite the routine use of a three-dimensional electroanatomical mapping system. With conservative use of fluoroscopy, fluoroscopy times <20 minutes are easily achievable using the manual approach. Although catheter displacements were less common with RRN, this had no impact on procedure time or efficacy. Therefore, the main advantage of RRN appears to be comfort for the operator, who is able to sit in the control booth during the ablation process.
Keywords: Atrial Appendage, Atrial Fibrillation, Arrhythmias, Cardiac, Catheter Ablation, Fluoroscopy, Heart Atria, Multivariate Analysis, Pulmonary Veins, Radiation Dosage, Robotics
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