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

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Abstract

Background

Robotic (RNS) or magnetic navigation systems (MNS) are available for remotely performed catheter ablation for atrial fibrillation (AF).

Objective

The present study compares remotely assisted catheter navigation (RAN) to standard manual navigation (SMN) and both systems amongst each other.

Methods

The analysis is based on a sub-cohort enrolled by five hospitals from the multicenter German ablation Registry.

Results

Out of 2442 patients receiving catheter ablation of AF, 267 (age 61.4 ± 10.4, 69.7% male) were treated using RAN (RNS n = 187, 7.7% vs. MNS n = 80, 3.3%). Fluoroscopy time [RNS median 17 (IQR 12–25) min vs. MNS 22 (16–32) min; p < 0.001] and procedure duration [RNS 180 (145–220) min vs. MNS 265 (210–305) min; p < 0.001] were significantly different. Comparing RAN (11%) to SMN (89%) fluoroscopy time (RAN 19 (13–27) min, vs. SMN 25 (16–40) min; p < 0.001), energy delivery (RAN 3168 (2280–3840) s vs. SMN 2640 (IQR 1799–3900) s; p = 0.008) and procedure duration [RAN 195 (150–255) min vs. SMN 150 (120–150) min; p = 0.001] differed significantly. In terms of acute and 12 months outcome, no differences were seen between the two systems or in comparison to SMN.

Conclusion

AF ablation can be performed safely, with high acute success rates using RAN. RNS results in less fluoroscopy burden and shorter procedure durations. Compared to SMN, a reduced fluoroscopy burden, prolonged procedure and ablation duration were observed using RAN. Overall, the number of RAN procedures is small suggesting low impact on clinical routine of AF ablation.

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Authors and Affiliations

  1. Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Jan-Hendrik van den Bruck, Arian Sultan, Jakob Lüker & Daniel Steven

  2. Department of Cardiology, University Hospital, Heidelberg, Germany

    Dierk Thomas

  3. Department of Cardiology and Angiology, Helios-Klinikum, Pforzheim, Germany

    Kai Weinmann

  4. Department of Cardiology, Heart Center Kerckhoff-Klinik, Bad Nauheim, Germany

    Malte Kuniss

  5. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

  6. Department of Cardiology, Vivantes Hospital, Berlin, Germany

    Dietrich Andresen

  7. Department of Cardiology, Hospital Coburg, Coburg, Germany

    Johannes Brachmann

  8. Asklepios-Hospital St. Georg, Hamburg, Germany

    Karl-Heinz Kuck

  9. Department of Cardiology, University Hospital Schleswig-Holstein, Lübeck, Germany

    Roland Tilz

  10. Department of Electrophysiology, Heart Center University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Stephan Willems

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  1. Jan-Hendrik van den Bruck
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Correspondence to Jan-Hendrik van den Bruck.

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van den Bruck, JH., Sultan, A., Lüker, J. et al. Remote vs. conventional navigation for catheter ablation of atrial fibrillation: insights from prospective registry data. Clin Res Cardiol 108, 298–308 (2019). https://doi.org/10.1007/s00392-018-1356-6

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  • DOI: https://doi.org/10.1007/s00392-018-1356-6

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