Key result
Robotically assisted ablation resulted in greater acute LGE encirclement compared to standard ablation (72% vs 60%, P=0.002) and required fewer procedures at 3 years (1.3 vs 1.9, P<0.001).
Why the study?
Does robotically assisted catheter ablation increase late gadolinium enhancement around the pulmonary vein antrum and reduce re-do procedures compared to standard ablation in patients with paroxysmal atrial fibrillation?
RCT (n=40)
randomized
Does robotically assisted catheter ablation increase late gadolinium enhancement around the pulmonary vein antrum and reduce re-do procedures compared to standard ablation in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 72% vs 60%
p-value: p=0.002
Robotically assisted ablation for paroxysmal atrial fibrillation produces more extensive durable lesions on CMR and reduces the need for repeat procedures over 3 years.
May warrant consideration to reduce repeat procedures in paroxysmal AF; extends acute lesion data to 3-year clinical outcomes.
AIMS: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%. CONCLUSION: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.
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Arujuna et al. (2015) conducted an RCT in paroxysmal atrial fibrillation (n=40). robotic-assisted navigation vs. standard navigation was evaluated on mean percentage encirclement by LGE on acute imaging (p=0.002). Robotically assisted ablation resulted in greater acute LGE encirclement compared to standard ablation (72% vs 60%, P=0.002) and required fewer procedures at 3 years (1.3 vs 1.9, P<0.001).
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