Key result
Remote robotic navigation for pulmonary venous antra isolation significantly reduced total procedural time (207 vs 250 minutes, P=0.007) and fluoroscopy exposure compared to conventional ablation.
Why the study?
Does remote robotic catheter navigation reduce procedural time and radiation exposure in patients with drug refractory paroxysmal atrial fibrillation?
Observational (n=38)
Does remote robotic catheter navigation reduce procedural time and radiation exposure in patients with drug refractory paroxysmal atrial fibrillation?
Absolute Event Rate: 207% vs 250%
p-value: p=0.007
Robotic navigation for PVAI in paroxysmal AF is safe and significantly reduces procedural time and radiation exposure compared to manual ablation.
May improve efficiency and cut radiation in paroxysmal AF ablation; leaves open confirmation via randomized trials before practice change.
INTRODUCTION: Pulmonary venous antra isolation (PVAI) is the cornerstone of catheter ablation procedure for drug refractory paroxysmal atrial fibrillation (AF). However, the procedure is technically challenging. Robotic navigation has a potential to expedite and facilitate the procedure. METHODS: A robotic catheter control system was used for remote navigation-supported PVAI in 22 patients (mean age = 55 +/- 9 years, 16 males, study group). An irrigated-tip catheter with estimate of catheter force on the tissue was used. This was compared in nonrandomized fashion with conventional hand-controlled catheter ablation in 16 patients (mean age = 55 +/- 9 years, 13 males, control group). The procedures were performed under guidance of Ensite NavX navigation system (St. Jude Medical, St. Paul, MN, USA) and intracardiac echocardiography. RESULTS: Robotic navigation was associated with significantly shorter overall duration of radiofrequency delivery (1,641 +/- 609 vs 2,188 +/- 865 seconds, P < 0.01), shorter total procedural time (207 +/- 29 vs 250 +/- 62 minutes, P = 0.007), fluoroscopy exposure (15 +/- 5 vs 27 +/- 9 minutes, P < 0.001), and lower radiation dose (1,119 +/- 596 vs 3,048 +/- 2,029 mGy/m(2), P < 0.001). No complication was observed in either the study or the control group. During the 5 +/- 1 months follow-up in the study group and 9 +/- 3 months in the control group, 91% and 81% of patients, respectively, were AF free. CONCLUSIONS: In our early clinical experience, PVAI using a remote robotic catheter navigation was effective, safe, and associated with shorter procedural and fluoroscopic times than conventional PVAI.
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Kautzner et al. (2009) conducted an observational in Drug refractory paroxysmal atrial fibrillation (n=38). Remote robotic navigation-supported pulmonary venous antra isolation vs. Conventional hand-controlled catheter ablation was evaluated on Total procedural time (minutes) (p=0.007). Remote robotic navigation for pulmonary venous antra isolation significantly reduced total procedural time (207 vs 250 minutes, P=0.007) and fluoroscopy exposure compared to conventional ablation.
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