Robotic Hybrid Ablation with Novel Epicardial Electrophysiological Mapping: Impact on Atrial Fibrillation Therapy

We report the first use of the EnSite X system for intraoperative electrophysiological mapping during a robotic hybrid ablation (ROK-AF procedure) for long-standing persistent atrial fibrillation. Epicardial ablation targets were identified through epicardial mapping, and post-ablation electrical silencing was validated using the mapping system. Unlike conventional electrophysiological mapping systems, the orientation-independent omnipolar technology in EnSite X provides directional activation vectors, high-resolution electrograms, and peak frequency analysis, thereby enhancing substrate characterization. Post-ablation mapping confirmed the successful silencing of the posterior left atrial wall, demonstrating EnSite X's efficacy in real-time guidance for hybrid atrial fibrillation ablation and its potential to enhance robotic surgical workflows, potentially yielding more precise ablations.