Long-term clinical outcomes of magnetically navigated rotor ablation as an adjunct to conventional pulmonary vein isolation

Aims: The objective of this study is to evaluate the outcomes of magnetically guided ablation of atrial fibrillation (AF) rotors in conjunction with magnetically guided pulmonary vein isolation (PVI) in a large consecutive series of patients. Methods and results: A total of 110 consecutive patients with drug-refractory AF underwent rotor ablation followed by conventional PVI and ablation of other spontaneous arrhythmias, all of which were performed with remote magnetic navigation (RMN). The patients were followed to assess the recurrence of atrial arrhythmia. Patients had a mean age of 62.5 ± 9.9 years, 64.5% had persistent AF, and 36.4% had a prior failed PVI. All patients had mapped rotors (3.9 ± 1.5 per patient), with right atrial (RA) rotors in 77.3% (85/110) of patients. After a mean follow-up of 17.6 ± 9.5 months, 90.9% (100/110) were in stable sinus rhythm including patients on previously ineffective antiarrhythmic drugs (AADs). 69.1% (76/110) were in stable sinus rhythm without any AADs. Outcome did not differ between patients with persistent or paroxysmal AF (69.2% vs. 69.0%; P = 0.75), failed prior ablation or those undergoing an initial ablation (77.5% vs. 64.3%; P = 0.193), or patients with and without intra-procedural AF termination (67.3% vs. 70.5%; P = 0.723). Conclusion: Ablation of rotors in combination with PVI using RMN was associated with a high success rate in this large cohort of consecutive patients. Significant proportion of patients exhibited RA rotors, which was associated with persistent AF, obstructive sleep apnoea, and obesity.