Robotic magnetic navigation for atrial fibrillation ablation.
OBJECTIVE
We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein ablation (CPVA).


BACKGROUND
No data are available on feasibility of remote navigation for AF ablation.


METHODS
Forty patients underwent CPVA for symptomatic AF using the NIOBE II remote magnetic system (Stereotaxis Inc., St. Louis, Missouri). Ablation was performed with a 4-mm tip, magnetic catheter (65 degrees C, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field (0.08-T), and a motor drive (Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system (Stereotaxis Inc.). End point of ablation was voltage abatement >90% of bipolar electrogram amplitude.


RESULTS
Remote ablation was successful in 38 of 40 patients without complications. The median mapping and ablation time was 152.5 min (range, 90 to 380 min) but was much longer in the first 12 patients (192.5 min vs. 148 min; p = 0.012). Median ablation time was 49.5 min (range, 17 to 154 min), but it was much shorter in the last 28 patients than in the first 12 patients (49 min vs. 70 min; p = 0.021). Patients receiving remote ablation had longer procedure times than control patients (p < 0.001) with similar mapping time but shorter ablation time on right-sided pulmonary veins. Many more mapping points regardless of their location were collected remotely (p < 0.001).


CONCLUSIONS
Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all procedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.
Department of Electrophysiology, San Raffaele Scientific Institute, Milan, Italy. carlo.pappone@hsr.it
Carlo
C
Pappone
Gabriele
G
Vicedomini
Francesco
F
Manguso
Filippo
F
Gugliotta
Patrizio
P
Mazzone
Simone
S
Gulletta
Nicoleta
N
Sora
Simone
S
Sala
Alessandra
A
Marzi
Giuseppe
G
Augello
Laura
L
Livolsi
Andreina
A
Santagostino
Vincenzo
V
Santinelli
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D018583:Pliability; D012371:Robotics; D016896:Treatment Outcome