Improved procedural efficiency of atrial fibrillation ablation using robotic magnetic navigation

Background Currently, there is still a large variability in procedural efficiency of atrial fibrillation (AF) ablation. Objectives To evaluate the evolution of procedural efficiency of AF ablation using robotic magnetic navigation (RMN), and compared the most efficient approach against cryoballoon ablation (CRYO), a typical "single-shot" technique. Methods A total of 2,028 AF ablation procedures with RMN were consecutively included and divided into three groups based on ablation technique evolution [Group 1, ablation catheter with fixed sheath, standard power-long duration (SPLD), n=523; Group 2, steerable sheath, SPLD, n=994; Group 3, steerable sheath, high power- short duration (HPSD), n=511]. For comparison, patients treated with the most efficient ablation strategy with RMN (n=85) or CRYO (n=85) were matched using a 1:1 propensity score and analyzed within the same period. Results RMN-Group 3 was the most efficient ablation strategy with the shortest procedure time ( P <0.001) and its radiofrequency time decreased abruptly by 65% (Group 2, P <0.001) and 73% (Group 1, P <0.001). Major complication rates of these three groups were 0.2%, 0.3% and 0.2% respectively ( P =0.89). Comparable procedure time was revealed between matched-RMN-Group 3 and CRYO group (64 ± 17.4 min vs 62±14.5 min, P =0.49) after propensity score matching analysis. At 12 months, 81% of matched-RMN-Group 3 and 80% of CRYO patients remained free from recurrent atrial tachyarrhythmias ( P =0.63). Conclusions The procedural efficiency of RMN-guided AF ablation has been remarkably improved with steerable sheath and HPSD ablation. This technique is generally equivalent to CRYO with regarding to procedure time and overall efficacy.