Comparison of the Mid-Term Outcomes of Robotic Magnetic Navigation-Guided Radiofrequency Ablation versus Cryoballoon Ablation for Persistent Atrial Fibrillation

Abstract

Introduction: Currently, numerous ablation techniques are available for atrial fibrillation (AF), in addition to manual radio frequency ablation. The aim of this prospective, non-randomized concurrent controlled trial was to compare the mid-term efficacy and procedural outcomes of persistent AF (PerAF) using cryoballoon (CB) and robotic magnetic navigation (RMN). Methods: Two hundred PerAF patients were assigned, in a 1:1 ratio, to undergo catheter ablation using RMN (RMN group) or CB (CB group). The primary endpoint was freedom from AF recurrence following a 3-month period after the index ablation. The secondary endpoint was peri-procedural outcomes, including the total procedure time, left atrial procedure time, fluoroscopy time, and fluoroscopy dose. The Two-step cluster analysis was used to determine the efficacy of RMN and CB between the different groups. The Cox proportional hazard model and restricted cubic spline were used to determine predictors for AF recurrence. Results: At the mean follow-up of 28.1 ± 9.7 months, the primary endpoint was achieved in 71 PerAF patients in the RMN group and in 62 PerAF patients in the CB group (71% vs. 62%, p = 0.158). Compared with CB, RMN-guided ablation led to a longer procedure time (p < 0.001), but with less radiation (p < 0.001). Cluster analysis returned two clusters of patients and RMN was favorable for one cluster (p = 0.037), in which more patients presented with diabetes mellitus and smaller left atria. Conclusions: For patients with PerAF, CB is generally equivalent to RMN-guided ablation with regard to overall efficacy. RMN-guided ablation could be favorable in specific patient populations presenting with diabetes mellitus and smaller left atria.

Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation

“…Adjustment of the application time and the necessity of additional freezing were left to the operator's discretion. 9 If the nadir temperature of the balloon exceeded −55°C, the ablation would be terminated.…”

“…Successful PVI was defined as an absence of any PV potentials or their dissociation from any atrial activity. Adjustment of the application time and the necessity of additional freezing were left to the operator's discretion 9 . If the nadir temperature of the balloon exceeded −55°C, the ablation would be terminated.…”

“…Adjustment of the application time and the necessity of additional freezing were left to the operator's discretion. 9 If the nadir temperature of the balloon exceeded −55°C, the ablation would be terminated. Atrial burst pacing and routine pharmacological testing with isoproterenol were performed to identify non-PV triggers after PVI.…”

New Perspectives on Risk Stratification and Treatment in Patients with Atrial Fibrillation: An Analysis of Recent Contributions on the Journal of Cardiovascular Disease and Development

“…The two systems (i.e., POLARx, Boston Scientific vs. Arctic Front Advance-Pro, AFA, Medtronic) were both effective and safe in AF patients, with some differences in procedure and fluoroscopy times as well as nadir temperatures. Comparing the mid-term efficacy and procedural outcomes of persistent AF patients with CB and robotic magnetic navigation (RMN), Li and colleagues [ 55 ] found that CB is generally equivalent to RMN-guided ablation. The PF-CA may be an additional resource in the future of AF ablation for its extreme specificity in inducing apoptosis in the myocardiocytes by electroporation.…”

Radiation Risks and Interventional Cardiology: The Value of Radiation Reduction Exposure

“…Additionally, the percutaneous transcatheter radiofrequency ablation of atrial fibrillation with remote-controlled magnetic navigation has recently been shown to provide comparable success rates with reduced fluoroscopy time and radiation exposure for both patients and physicians as compared to conventional manual ablation techniques [ 13 , 14 ].…”