Robotic Magnetic Navigation Versus Manual Catheter Ablation for Premature Ventricular Contractions: A Single-center...

Robotic magnetic navigation (RMN) offers potential advantages for premature ventricular contraction (PVC) ablation, including improved catheter stability and reduced operator radiation exposure, but comparative data versus conventional manual ablation for PVCs are limited. The objective of this study was to compare procedural metrics and very short-term clinical outcomes-specifically, 1-month symptom status, class I/III anti-arrhythmic drug (AAD) use, and periprocedural complications-between RMN-guided and manual PVC ablation in a single-center experience. We performed a retrospective cohort study of consecutive patients undergoing PVC ablation at a single center between 2019 and 2023. Patients were categorized by technique: conventional manual ablation or RMN using the Niobe ES system (Stereotaxis, St. Louis, MO, USA). Of 93 unique patients, 74 initially underwent RMN and 19 underwent manual ablation. Seven RMN cases requiring intraprocedural conversion to manual ablation were excluded from the primary comparison, yielding a per-protocol analytic cohort of 86 patients (67 RMN and 19 manual). Baseline characteristics, including age, left ventricular ejection fraction (LVEF), comorbidities, pre-procedure PVC burden, and class I/III AAD use, were compared between groups. The primary endpoints were total procedure time and fluoroscopy time, while secondary endpoints included 1-month symptom resolution, post-procedure class I/III AAD use, and periprocedural complications. An intention-to-treat sensitivity analysis grouped converted cases with the RMN-initial cohort. Baseline characteristics were similar between the RMN and manual cohorts (mean age, 62.8 ± 13.1 vs. 62.2 ± 12.8 years; LVEF, 46.2% ± 13.5% vs. 50.8% ± 14.8%; left ventricular [LV] systolic dysfunction [LVEF < 50%], 44.8% vs. 31.6%; all P > .2). Mean procedure times were comparable (212.3 ± 67.3 vs. 218.5 ± 74.7 min; P = .747), as were fluoroscopy times (12.3 ± 7.2 vs. 12.4 ± 9.0 min; P = .968). At 1 month, symptom resolution was documented in 74.6% (47/63) of RMN patients and 62.5% (10/16) of manual patients (P = .514). Class I/III AAD use decreased from 89.6% to 61.2% in the RMN group and from 89.5% to 68.4% in the manual group (net change, -28.4% vs. -21.1%; P value for post-procedure comparison = .759) without a statistically significant between-group difference. Periprocedural complications did not differ significantly (3.0% RMN vs. 5.3% manual; P = .532): one tamponade occurred in the manual group, and one pericardial effusion and one pseudoaneurysm occurred in the RMN group. In this single-center retrospective cohort, RMN-guided PVC ablation achieved procedure times, fluoroscopy times, very short-term symptom outcomes, and complication rates comparable to conventional manual ablation, with substantial reductions in class I/III AAD use in both groups at 1 month. Findings were similar in an intention-to-treat sensitivity analysis that grouped converted cases with the RMN-initial cohort. Because post-ablation PVC burden and follow-up LV function were not systematically assessed, these results should be interpreted as hypothesis-generating and limited to procedural efficiency and early, largely subjective outcomes.