title: Remote robotic navigation and electroanatomical mapping for ablation of atrial fibrillation: considerations for navigation and impact on procedural outcome.
abstract: BACKGROUND
  Radiofrequency current ablation of atrial fibrillation (AF) requires high technical skills to achieve optimal catheter stability and is associated with an individually high x-ray exposure to both the patient and the operator. To facilitate catheter navigation and to reduce the operator's x-ray burden, remote navigation (RN) systems have been developed. Considerations for navigation of a novel remote robotic navigation system in pulmonary vein isolation (PVI) procedures are reported.
  
  
  RESULTS
  In 65 patients with drug-refractory AF (43 paroxysmal, 22 persistent), complete circumferential PVI was performed using RN in conjunction with different electroanatomic mapping systems. Acute complete PVI using exclusively RN was achieved in 95%. The procedure time was 195+/-40 minutes. The operator's x-ray exposure time was reduced by 6+/-4 minutes (35%) using RN. In 7 of 14 patients with persistent AF, conversion to sinus rhythm was achieved by radiofrequency current ablation. During a median follow-up period of 239 days (range, 184 to 314 days), 47 of 65 patients (73%) remained free of any documented atrial tachyarrhythmia recurrences after a single procedure. The relative proportion of patients remaining free of AF was 76% and 68% for paroxysmal and persistent AF, respectively.
  
  
  CONCLUSIONS
  PVI using the novel RN system can be performed safely and effectively. One third of the operator's fluoroscopy exposure time might be saved using RN. However, the questions of whether the overall fluoroscopy exposure is reduced by RN and whether RN improves PVI procedures needs to be assessed during a comparative trial between man and machine.
authors.affiliation: Hanseatisches Herzzentrum Hamburg, Asklepios Klinik St Georg, 20099 Hamburg, Germany. bor.schmidt@asklepios.com
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Roland R
authors.initials: RR
authors.lastname: Tilz
authors.forename: Kars
authors.initials: K
authors.lastname: Neven
authors.forename: K R
authors.initials: KR
authors.lastname: Julian Chun
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D013502:General Surgery; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery; D011829:Radiation Dosage; D012371:Robotics