Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation

Abstract

Background

Long-term results after circumferential pulmonary vein isolation (CPVI) for the treatment of paroxysmal atrial fibrillation (PAF) using a robotic navigation system (RNS) have not yet been reported.

Objective

To evaluate long-term results of patients with PAF after CPVI using RNS.

Methods

In this study, 200 patients (n = 151 (75.5 %) male; median age 62.2 (54.7–67.7) years) with PAF were evaluated. In 100 patients, RNS (RN-group) was used for CPVI and compared to 100 manually ablated control patients (MN-group). Radiofrequency was used in conjunction with 3D electroanatomic mapping. Power was limited to 30 watts (W) at the posterior left atrial (LA) wall in the first 49 RNS patients (RN-group-a). After esophageal perforation occurred in one RN-group-a patient, maximum power was reduced to 20 W for the subsequent 51 patients (RN-group-b).

Results

After a median follow-up of 2 years, single (77/100 vs 77/100, p = 0.89) and multiple (90/100 vs 93/100, p = 0.29) procedure success rates were comparable between RN-group and MN-group. Single procedure success rate was significantly lower in RN-group-a as compared to RN-group-b (65.3 vs 88.2 %, p = 0.047). In RN-group-a patients, procedural times [200 (170–230) vs 152 (132–200) minutes, p < 0.01] and fluoroscopy times [16.6 (12.9–21.6) minutes vs 13.7 (9.5–19) minutes, p = 0.043] were significantly longer compared to RN-group-b patients.

Conclusion

Long-term success rate after CPVI using RNS was comparable to manual ablation. Despite a lower power limit of 20 W at the posterior LA wall, single procedure success rate was higher in RN-group-b as compared to RN-group-a. Procedure time and fluoroscopy time decreased, whilst success rate increased with increasing experience in the RN-group.

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Correspondence to Andreas Rillig.

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Conflict of interest

Andreas Rillig received travel grants from Biosense Webster, Hansen Medical and St. Jude Medical and lecture fees from St. Jude Medical and takes part at the Boston scientific EP fellowship; Tina Lin received a fellowship grant from EHRA and travel grants from Biosense Webster, St. Jude Medical and Topera Medical. Roland Tilz received research grants from Hansen, St. Jude Medical, travel grants from St. Jude Medical, Topera, Biosense Webster, Daiichi Sankyo, Sentrheart and speaker‘s bureau honoraria from Biosense Webster, Biotronik, Pfizer, Topera, Bristol-Myers Squibb; Bayer, Sanofi Aventis. Prof. Kuck has received research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, and Cryocath; and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis.

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Rillig, A., Lin, T., Schmidt, B. et al. Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation. Clin Res Cardiol 105, 106–116 (2016). https://doi.org/10.1007/s00392-015-0892-6

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Keywords

  • Paroxysmal atrial fibrillation
  • Long-term outcome
  • Robotic navigation
  • Catheter ablation
  • Pulmonary vein isolation
  • Learning effect