Efficacy and safety of remote magnetic catheter navigation vs. manual steerable sheath-guided ablation for catheter ablation of atrial fibrillation: a case-control study

Koutalas, Emmanuel; Bertagnolli, Livio; Sommer, Philip; Richter, Sergio; Rolf, Sascha; Breithardt, Ole A.; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

doi:10.1093/europace/euu224

Cited by 15 publications

(19 citation statements)

References 23 publications

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“…The results of our analysis revealed a comparable success rate in patients undergoing RMN assisted ablation and MAN catheter ablation. This is consistent with current published literature [16,19,26,27,32]. The flexible catheter used for remote magnetic navigation theoretically facilitates electroanatomic mapping by having a “lighter” tissue touch and thus decreasing distortion of the endocardial border at the catheter tip site.…”

Section: Discussionsupporting

confidence: 91%

“…The flexible catheter used for remote magnetic navigation theoretically facilitates electroanatomic mapping by having a “lighter” tissue touch and thus decreasing distortion of the endocardial border at the catheter tip site. Precise control of the catheter also aids complex ablation procedures by overcoming the difficulty of ablating hard‐to‐access sites as compared with conventional curvature catheter ablation (commonly the right lower pulmonary vein in atrial fibrillation ablation) [32]. Although the lack of contact force and charring of the catheter tip in the era of solid tip remote magnetic navigation catheters resulted in a higher rate of procedural failure initially, this is rarely seen nowadays with the utilization of irrigated tip catheters.…”

Section: Discussionmentioning

confidence: 99%

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Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction

Lim¹,

Toh²,

Loh³

et al. 2016

Journal of Arrhythmia

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BackgroundPercutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote controlled magnetic navigation (RMN) has been shown to reduce radiation exposure to patients and physicians compared with conventional manual (MAN) ablation techniques.MethodsCatheter ablation for atrial fibrillation was performed utilizing RMN in 214 consecutive patients and MAN ablation techniques in 229 patients. We compared the fluoroscopy and procedural times between RMN and MAN catheter ablation of atrial fibrillation. Secondary objectives included comparing acute procedural success and short-term complication rates between both ablation strategies.ResultsFluoroscopy time was significantly shorter in the RMN group than the MAN group (53.5±30.1 vs 68.1±27.6 min, respectively; p<0.01); however, the total procedural time was longer in the RMN group (280.2±74.4 min vs 213.1±64.75, respectively; p>0.001). Further subgroup analysis of the most recent 50 ablations each from the RMN and MAN groups, to attenuate the RMN learning curve effect, showed an even greater difference in fluoroscopy time (RMN vs MAN: 53.5±30.1 vs 68.1±27.6 min), though a consistently longer procedure time with RMN (249.5±65.5 vs 186.3±65.6 min, respectively). The acute procedural success rate was comparable between the groups (98.6% vs 95.6%, respectively; p=0.07). The rates of acute complications were similar in both groups (2.3% vs 4.8%, respectively; p=0.16).ConclusionsIn radiofrequency ablation of atrial fibrillation, RMN appears to significantly reduce fluoroscopy time compared with conventional MAN ablation, though at a cost of increased total procedural time, with comparable acute success rates and safety profile. A reduction in procedure and fluoroscopy times is possible with gaining experience.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction

Lim¹,

Toh²,

Loh³

et al. 2016

Journal of Arrhythmia

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“…[22][23][24]26 One study showed a trend towards lower long-term success rates with RMN-guided ablation of persistent AF when compared to manual ablation. 21 guided ablation is associated with lower fluoroscopy times, comparable procedure times and comparable success rates when compared to manual ablation. 27,29,30 However, all of these studies are limited by its observational design, which introduces selection bias into the analyses.…”

Section: Amigo Remote Catheter Systemmentioning

confidence: 99%

Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches

Bassil

Markowitz

Liu

et al. 2020

Cardiovasc electrophysiol

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Robotic technology has emerged as an important tool to facilitate catheter ablation of arrhythmias. Robotic cardiac electrophysiology technology includes remote magnetic navigation and manual robotic navigation. Robotics can confer advantages with respect to ease of catheter manipulation in anatomically challenging spaces, minimization of fluoroscopic exposure to both patients and operators, and reduction in operator fatigue. This review provides a comprehensive summary of robotic electrophysiology technology, its practical applications and its safety and efficacy for targeting cardiac arrhythmias.

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“…Second, for this study no deflectable sheath was used during ablation, which might improve the procedural success. 21 Third, long-term results are needed to fully assess efficacy.…”

Section: Limitationsmentioning

confidence: 99%

Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation: Experience from 1,006 Procedures

Pehrson

Jacobsen

et al. 2016

Cardiovasc electrophysiol

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RMN-Guided Ablation for AF. Background:The objective of this study was to assess the procedural outcomes of catheter ablation guided by remote magnetic navigation (RMN) in a large cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent AF (PerAF).Methods: A total of 726 patients (547 male, age: 58.5 ± 10.3 years) with symptomatic AF (61% PAF) were analyzed from a prospective ablation registry. Procedural parameters including pulmonary venous (PV) anatomy, left atrial (LA) volume, procedural time, ablation time, fluoroscopy time, total X-ray dose, and complications were assessed.Results: One thousand and six ablation procedures were analyzed. One-third of the patients (240/726) were ablated on more than one occasion, resulting in a mean of 1.3 ± 0.6 times for the entire group. When analyzing all procedures, the mean procedural time and ablation time was 134 ± 35 minutes and 2,130 ± 1,025 seconds, respectively. The mean fluoroscopy time was 5.4 ± 3.7 minutes. Compared to PAF patients, procedural time and ablation time were significantly increased in patients with PerAF by 10% (P < 0.001) and 19% (P < 0.001), respectively. However, fluoroscopy time was not increased (5.3 ± 3.5 minutes, PAF vs. 5.6 ± 4.0 minutes, PerAF, P = 0.17). The overall complication rate was 0.6%. One PAF patient experienced cardiac tamponade. AF repeat ablations by RMN significantly reduced the procedural and ablation times when compared with their first ablation times.Conclusions: AF ablation guided by RMN is safe as evidenced by a low complication rate. Fluoroscopy time was relatively short for both PAF and PerAF

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Efficacy and safety of remote magnetic catheter navigation vs. manual steerable sheath-guided ablation for catheter ablation of atrial fibrillation: a case-control study

Abstract: Although in patients with persistent AF, the recurrence rate is higher in RMN group, the outcome is comparable between RMN and MCN groups in patients with paroxysmal AF. A multicentre prospective randomized study is warranted to clarify this issue.

Cited by 15 publications

References 23 publications

Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction

Remote magnetic catheter navigation versus conventional ablation in atrial fibrillation ablation: Fluoroscopy reduction

Robotics for catheter ablation of cardiac arrhythmias: Current technologies and practical approaches

Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation: Experience from 1,006 Procedures

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