title: Remote magnetic with open-irrigated catheter vs. manual navigation for ablation of atrial fibrillation: a systematic review and meta-analysis.
abstract: The aim of this study was to determine the efficacy and safety of remote magnetic navigation (RMN) with open-irrigated catheter vs. manual catheter navigation (MCN) in performing atrial fibrillation (AF) ablation. We searched in PubMed (1948-2013) and EMBASE (1974-2013) studies comparing RMN with MCN. Outcomes considered were AF recurrence (primary outcome), pulmonary vein isolation (PVI), procedural complications, and data on procedure's performance. Odds ratios (OR) and mean difference (MD) were extracted and pooled using a random-effect model. Confidence in the estimates of the obtained effects (quality of evidence) was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. We identified seven controlled trials, six non-randomized and one randomized, including a total of 941 patients. Studies were at high risk of bias. No difference was observed between RMN and MCN on AF recurrence [OR 1.18, 95% confidence interval (CI) 0.85 to 1.65, P = 0.32] or PVI (OR 0.41, 95% CI 0.11-1.47, P = 0.17). Remote magnetic navigation was associated with less peri-procedural complications (Peto OR 0.41, 95% CI 0.19-0.88, P = 0.02). Mean fluoroscopy time was reduced in RMN group (-22.22 min; 95% CI -42.48 to -1.96, P = 0.03), although the overall duration of the procedure was longer (60.91 min; 95% CI 31.17 to 90.65, P < 0.0001). In conclusion, RMN is not superior to MCN in achieving freedom from recurrent AF at mid-term follow-up or PVI. The procedure implies less peri-procedural complications, requires a shorter fluoroscopy time but a longer total procedural time. For the low quality of the available evidence, a proper designed randomized controlled trial could turn the direction and the effect of the dimensions explored.
authors.affiliation: Cardiac Electrophysiology Laboratory, Luigi Sacco Hospital, Via G. B. Grassi, 72, 20156 Milan, Italy. riccardoproietti6@gmail.com
authors.forename: Riccardo
authors.initials: R
authors.lastname: Proietti
authors.forename: Valentina
authors.initials: V
authors.lastname: Pecoraro
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Viecca
authors.forename: Antonio
authors.initials: A
authors.lastname: Sagone
authors.forename: Alessio
authors.initials: A
authors.lastname: Galli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.forename: Ludovica
authors.initials: L
authors.lastname: Tagliabue
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D008280:Magnetics; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000401:mortality*; D015996:Survival Rate; D007507:Therapeutic Irrigation / Q000401:mortality* / Q000523:psychology; D016896:Treatment Outcome
keywords: Atrial fibrillation ablation; Remote magnetic navigation; Stereotaxis