Comparison Between Efficacy and Safety of Remote Magnetic Navigation and Manual Catheter Navigation for Atrial Fibrillation Ablation: An Updated Meta-analysis and Systematic Review

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  Figure 1:. Preferred Reporting Items for Systematic Review and Meta-analysis flow diagram demonstrating the search strategy and study selection process for the meta-analysis. Initially, 4085 articles were retrieved, followed by a review to identify duplicates and assess them based on their titles and abstracts. Ultimately, 22 observational studies fulfilled the inclusion criteria for the analysis.

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  Supplementary Figure S1:. Funnel plots of primary and secondary outcomes. A: Freedom from atrial fibrillation. B: Procedure time. C: Fluoroscopy time. D: Total complication rate. E: Acute success rate. F: Pericardial effusion with or without tamponade. G: Vascular access complications. H: Atrial fibrillation recurrence rate. I: Ablation time. J: Radiofrequency application duration. Abbreviations: AF, atrial fibrillation; RF, radiofrequency.

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  Figure 2:. A: Forest plot of freedom from atrial fibrillation (AF). This figure summarizes a pooled analysis of 16 studies (4071 patients) on freedom from AF, showing no significant difference between remote magnetic navigation and manual catheter navigation procedures. B: Forest plot of freedom from AF with sensitivity analysis. This figure shows a sensitivity analysis of freedom from AF, with a reduction in heterogeneity from 73% to 50% achieved by excluding Schlögl et al.35 Abbreviations: AF, atrial fibrillation; CI, confidence interval; M–H, Mantel–Haenszel; MCN, manual catheter navigation; RMN, remote magnetic navigation; RR, relative risk.

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  Figure 3:. Forest plot of procedure time. This figure shows a pooled analysis of 21 studies, indicating that remote magnetic navigation prolonged procedure times by 48.58 min compared to manual catheter navigation. Abbreviations: CI, confidence interval; IV, inverse variance; MCN, manual catheter navigation; MD, mean difference; RMN, remote magnetic navigation; SD, standard deviation.

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  Figure 4:. Forest plot of fluoroscopy time. This figure shows a pooled analysis of 22 studies, revealing that patients who underwent remote magnetic navigation had 12.52-min shorter fluoroscopy times than patients who underwent manual catheter navigation. Abbreviations: CI, confidence interval; IV, inverse variance; MCN, manual catheter navigation; MD, mean difference; RMN, remote magnetic navigation; SD, standard deviation.

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  Figure 5:. Forest plot of total complication rate. This figure presents a pooled analysis demonstrating a statistically significant decrease in complication rates for patients who underwent remote magnetic navigation compared to patients who underwent manual catheter navigation. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MCN, manual catheter navigation; RMN, remote magnetic navigation; RR, relative risk.