title: Remote robotic catheter ablation for atrial fibrillation: how fast is it learned and what benefits can be earned?
abstract: BACKGROUND
  Recently, results describing pulmonary vein isolation (PVI) on patients using a robotic navigation system (RNS) in a high-volume center specialized in pulmonary vein isolation were published. The main purpose of this prospective study was to evaluate the learning curve of new users of RNS in a community hospital and to address the effectivity of RNS in electrophysiological settings with fewer patients. Radiation times, procedural times, feasibility, and safety with the RNS were assessed.
  
  
  METHODS
  PVI using the RNS was performed on 100 consecutive patients with symptomatic paroxysmal (n = 56, 56%) or persistent atrial fibrillation (AF). To assess the learning curve of practitioners with first-time use of RNS, patients were divided into four groups of 25 patients each (Q1-Q4). Procedural times as well as radiation times, complications, and outcome after a 6-month follow-up period were assessed for each quartile. All patients were ablated by the same physician.
  
  
  RESULTS
  Comparing the four patient groups, a continuous and significant reduction of procedural and radiation times was seen in the first 75 patients (Q1-Q3), whereas no further improvement was seen in the consecutive patients (Q3-Q4). One pericardial tamponade occurred in the course of 100 patients (1%). Overall success rate after a 6-month follow-up period was 74% in patients with paroxysmal and persistent AF. Comparing the four quartiles there was a higher but non-significant number of patients with freedom of atrial fibrillation after a 6-month follow-up in the subsequent groups (Q2-Q4) when compared to group 1.
  
  
  CONCLUSIONS
  This data suggest that RNS is feasible and safe when performed in a community hospital with a significant reduction of radiation times and procedure times within the first 75 patients and with similar success and complication rates as compared to high-volume centers.
authors.affiliation: Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg, Vöhrenbacherstr, 23, 78050, Villingen-Schwenningen, Germany. arillig5@yahoo.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Udo
authors.initials: U
authors.lastname: Meyerfeldt
authors.forename: Ralf
authors.initials: R
authors.lastname: Birkemeyer
authors.forename: Fabian
authors.initials: F
authors.lastname: Treusch
authors.forename: Markus
authors.initials: M
authors.lastname: Kunze
authors.forename: Tomislav
authors.initials: T
authors.lastname: Miljak
authors.forename: Vlada
authors.initials: V
authors.lastname: Zvereva
authors.forename: Werner
authors.initials: W
authors.lastname: Jung
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011361:Professional Competence / Q000706:statistics & numerical data*; D011667:Pulmonary Veins / Q000601:surgery*; D012371:Robotics / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted; D013996:Time and Motion Studies; D016896:Treatment Outcome