Remote vs. conventional navigation for catheter ablation of atrial fibrillation: insights from prospective registry data

Bruck, Jan-Hendrik van den; Sultan, Arian; Lüker, Jakob; Thomas, Dierk; Willems, Stephan; Weinmann, K. S.; Kuniss, Malte; Hochadel, Matthias; Senges, Jochen; Andresen, Dietrich; Brachmann, Johannes; Kuck, Karl‐Heinz; Tilz, Roland Richard; Steven, Daniel

doi:10.1007/s00392-018-1356-6

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…(3) RMN procedure performed without Vdrive™/V-Loop™ system for remote navigation of circular mapping catheter; necessity of manual placement of the circular mapping catheter to different PVs during the procedure for conduction block confirmation Our study results are in line with multi-center German ablation registry data published by van den Bruck et al 24 . Sub-cohort analysis included 2442 patient undergoing AF catheter ablation using MAN (89%), RMN (3.3%) and Sensei robotic navigation system (Hansen Medical Inc) (7.7%).…”

Section: Discussionsupporting

confidence: 86%

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Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control

Jež¹,

Jadczyk²,

Lehar³

et al. 2020

BIOMED PAP

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Aims. This study aims to compare procedural parameters and clinical efficacy of remote magnetic navigation (RMN) vs. manual navigation (MAN) approach for radiofrequency ablation (RFA) in patients with atrial fibrillation (AF). Methods. 146 patients with AF were enrolled in the study. In the RMN group (n=57), patients were treated with the CARTO® 3 in combination with the Niobe ES system. In the MAN group (n=89), ablation was performed with the EnSite Velocity and TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up. Results. Mean procedure times (236.87±64.31 vs. 147.22±45.19 min, P<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, P<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 s, P<0.05) were all significantly higher in the RMN than in the MAN group, respectively. In the same order, mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm 2 , P=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min, P=0.08) were not statistically different. At 6-month follow-up, freedom from AF was similar in RMN and MAN group for paroxysmal (60.8% and 73%, respectively, P=0.42) and persistent AF (69.6% and 75.0%, respectively, P=0.77). Conclusions. Due to the fact that mid-term clinical outcomes showed no significant differences in AF recurrences between groups and manual ablation strategy provided more favorable results regarding acute procedural parameters, we can conclude that the remote magnetic navigation is not superior to the manual approach.

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Section: Discussionsupporting

confidence: 86%

“…It is worth noting however, that the registry included few RMN procedures (80 out of 2442) over the course of ∼3 years (July 2008 -May 2011) (ref. 24 ) and technology has advanced since that time. Furthermore, similar to our study, Lim et al retrospectively analysed 443 consecutive AF patients (229 MAN and 214 RMN cases).…”

Section: Discussionmentioning

confidence: 99%

Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control

Jež¹,

Jadczyk²,

Lehar³

et al. 2020

BIOMED PAP

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“…There are conflicting data regarding procedure time of RMNguided ablation. Some 24 have reported prolonged procedure time while others 25 have disagreed, reporting lower and desirable procedure time. Even published meta-analyses have reached differing conclusions, possibly due to dissimilar inclusion criteria.…”

Section: Fluoroscopy and Procedures Time Of Rmn-guided Ablationmentioning

confidence: 99%

Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large‐scale single‐center study

Zhang

et al. 2020

Clinical Cardiology

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Background Remote magnetic navigation (RMN)‐guided ablation has become an inspiring method of catheter ablation for tachyarrhythmias. Hypothesis Data from a large‐scale single center may provide further insight into the safety of and the learning curve for RMN‐guided ablation. Methods A total of 1003 catheter ablation procedures using RMN for conditions including supraventricular ventricular tachycardia, atrial tachyarrhythmias, and premature ventricular contraction/ventricular tachycardia (PVC/VT) were retrospectively analyzed from an ablation registry. Procedural outcomes, including procedure time, mapping time, X‐ray time, and RF time, were assessed. The complications were classified into two categories: major and minor. A subanalysis was used to illustrate the learning curve of RMN‐guided ablation by assessing procedure time and total X‐ray time of 502 atrial fibrillation (AF) ablation procedures. Results Among these procedures, 556 (55.4%) were AF and 290 (28.9%) were PVC/VT. Electrical pulmonary vein isolation was achieved in 99.0% of AF procedures, and acute success reached 90.3% in PVC/VT procedures. The overall complication rate was 0.5%. In the subanalysis of AF procedures, the overall procedure time and X‐ray time of procedures were short (125.9 ± 54.6 and 5.3 ± 3.9 minutes, respectively) and proceeded to decrease from the initial 30 procedures to about 300 procedures, where the learning curve reached plateau, demonstrating maximum procedure efficiency. Conclusions RMN‐guided ablation is safe, as verified by very low overall complication rate and reduced X‐ray time. In our study, even the first AF procedures had a relatively low procedure time and total X‐ray time, and procedure efficiency improved during the learning curve.

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“…Over the past 20 years, catheter-based, surgical, and hybrid ablation techniques have been shown to be more effective than drug therapy in achieving rhythm control in patients with AF [11][12][13]. In the RAAFT study, which enrolled patients not previously treated for AF, the superiority of ablative treatment in terms of relapses has been demonstrated (patients on drug therapy 63% relapse and ablative therapy 13%) [14].…”

Section: Introductionmentioning

confidence: 99%

Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review

Palamà

Nesti

Robles

et al. 2022

Cardiology Research and Practice

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In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.

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Remote vs. conventional navigation for catheter ablation of atrial fibrillation: insights from prospective registry data

Cited by 9 publications

References 36 publications

Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control

Comparison of atrial fibrillation ablation efficacy using remote magnetic navigation vs. manual navigation with contact-force control

Procedural outcomes and learning curve of cardiac arrhythmias catheter ablation using remote magnetic navigation: Experience from a large‐scale single‐center study

Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review

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