Robotic navigation shows superior improvement in efficiency for atrial fibrillation ablation

Background: Because of the expanding atrial fibrillation (AF) burden, AF catheter ablation (CA) techniques have to become more efficient. Efficient AF CA procedures are characterized by successful pulmonary vein isolation (PVI) within reasonable procedure time. Currently there are many PVI techniques available and all show substantial improvements over time. However, the magnitude of improvement in procedural efficiency has not yet been compared between different techniques. The aim of this study was to compare efficiency improvement between manually (MAN) guided, cryoballoon (CB) and remote magnetic navigation (RMN) guided PVI. Methods: A total of 221 patients were included in this retrospective study. Procedural parameters of 115 patients treated with firstgeneration PVI techniques (MAN-1, CB-1, RMN-1) performed in 2010, were compared to 106 patients who were treated with the latest, second generation techniques (MAN-2, CB-2, RMN-2). Efficiency was characterized by the following parameters: total ablation time, total procedure time, first pass isolation (FPI) (i.e. successful isolation after the first pulmonary vein (PV) encirclement) and touch-up rates. Results: Every technique showed significant improvement of procedure times from the first to the second generation (P<0.001). Inbetween second generation techniques, the procedure times were comparable. The greatest magnitude of procedure time improvement was observed within the RMN groups (δ-180min), which was significantly greater compared to CB (δ-48 min, P<0.001) and MAN (δ-98min, P=0.011) groups. The highest FPI rates were observed in RMN-2 (78% and 74%; left and right PVs respectively), which was significantly higher compared to other techniques (MAN-2: 24% and 24%; CB-2: 50% and 48%; P<0.001). Conclusions: The highest magnitude of efficiency improvement was detected in RMN guided PVI.