Improved procedural efficiency of atrial fibrillation ablation using robotic magnetic navigation

Currently, there is still a large variability in procedural efficiency of atrial fibrillation (AF) ablation.

This study aimed to evaluate the evolution of procedural efficiency of AF ablation using robotic magnetic navigation (RMN) and compare the most efficient approach with cryoballoon ablation (CRYO), a typical "single-shot" technique.

A total of 2028 AF ablation procedures with RMN were consecutively included and divided into 3 groups based on ablation technique evolution (group 1, ablation catheter with fixed sheath, standard-power, long-duration, n = 523; group 2, steerable sheath, standard-power, long-duration, n = 994; and group 3, steerable sheath, high-power, short-duration, n = 511). For comparison, patients treated with the most efficient ablation strategy with RMN (n = 85) or CRYO (n = 85) were matched using a 1:1 propensity score and analyzed within the same period.

RMN group 3 was the most efficient ablation strategy with the shortest procedure time (P < .001), and its radiofrequency time decreased abruptly by 65% (group 2, P < .001) and 73% (group 1, P < .001). Major complication rates of these 3 groups were 0.2%, 0.3%, and 0.2%, respectively (P = .89). Comparable procedure time was revealed between the matched RMN group 3 and the CRYO group (64 ± 17.4 minutes vs 62 ± 14.5 minutes; P = .49) after propensity score matching analysis. At 12 months, 81% of matched RMN group 3 and 80% of CRYO patients remained free from recurrent atrial tachyarrhythmias (P = .63).

The procedural efficiency of RMN-guided AF ablation has been remarkably improved with steerable sheath and high-power, short-duration ablation. This technique is generally equivalent to CRYO with regard to procedure time and overall efficacy.