title: Persistence of pulmonary vein isolation after robotic remote-navigated ablation for atrial fibrillation and its relation to clinical outcome.
abstract: OBJECTIVE
  A robotic navigation system (RNS, Hansen™) has been developed as an alternative method of performing ablation for atrial fibrillation (AF). Despite the growing application of RNS-guided pulmonary vein isolation (PVI), its consequences and mechanisms of subsequent AF recurrences are unknown. We investigated the acute procedural success and persistence of PVI over time after robotic PVI and its relation to clinical outcome.
  
  
  RESULTS
  Sixty-four patients (60.7 ± 9.8 years, 53 male) with paroxysmal AF underwent robotic circumferential PVI with 3-dimensional left atrial reconstruction (NavX™). A voluntary repeat invasive electrophysiological study was performed 3 months after ablation irrespective of clinical course. Robotic PVI was successful in all patients without complication (fluoroscopy time: 23.5 [12-34], procedure time: 180 [150-225] minutes). Fluoroscopy time demonstrated a gradual decline but was significantly reduced after the 30th patient following the introduction of additional navigation software (34 [29-45] vs 12 [9-17] minutes; P < 0.001). A repeat study at 3 months was performed in 63% of patients and revealed electrical conduction recovery in 43% of all PVs. Restudied patients without AF recurrence (n = 28) showed a significantly lower number of recovered PVs (1 (0-2) vs 2 (2-3); P = 0.006) and a longer LA-PV conduction delay than patients with AF recurrences (n = 12). Persistent block of all PVs was associated with freedom from AF in all patients. At 3 months, 67% of patients were free of AF, while reablation of recovered PVs led to an overall freedom from AF in 81% of patients after 1 year.
  
  
  CONCLUSIONS
  Robotic PVI for PAF is safe, effective, and requires limited fluoroscopy while yielding comparable success rates to conventional ablation approaches with PV reconduction as a common phenomenon associated with AF recurrences.
authors.affiliation: Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany. willems@uke.uni-hamburg.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.forename: Boris A
authors.initials: BA
authors.lastname: Hoffmann
authors.forename: Imke
authors.initials: I
authors.lastname: Drewitz
authors.forename: Kai
authors.initials: K
authors.lastname: Müllerleile
authors.forename: Muhammet Ali
authors.initials: MA
authors.lastname: Aydin
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Tushar V
authors.initials: TV
authors.lastname: Salukhe
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome