title: Efficacy and safety of remote magnetic catheter navigation vs. manual steerable sheath-guided ablation for catheter ablation of atrial fibrillation: a case-control study.
abstract: OBJECTIVE
  Data comparing remote magnetic catheter navigation (RMN) to manual catheter navigation (MCN) using steerable sheath for ablation of atrial fibrillation (AF) is lacking. The aim of the present case-control study was to seek AF recurrence data after AF ablation using RMN in comparison to MCN using steerable sheath in patients with either paroxysmal or persistent AF.
  
  
  RESULTS
  This study comprised 140 patients with AF (50% paroxysmal). Seventy were ablated utilizing RMN and 70 with MCN. Primary endpoint was defined as the time to first recurrence after index procedure. After 28.8 ± 18.9 months of follow-up, more patients in the MCN group using steerable sheath remained free of recurrence compared with RMN group [(59.1 vs. 40%, respectively, P = 0.031), in patients with persistent AF P = 0.057, while in patients with paroxysmal AF, P = 0.18]. Index procedure time (223.6 ± 44.2 vs. 170.8 ± 51.8 min, P < 0.001) and radiofrequency application time (75.4 ± 20.9 vs. 56.6 ± 24.9 min, P < 0.001) were longer in the RMN group; however, the respective total fluoroscopy time (13.7 ± 7.8 vs. 36.6 ± 12.7 min, P < 0.001) was significantly shorter. In multivariable Cox-regression analysis, RMN was the only factor independently associated with shorter time to first recurrence during follow-up (P = 0.048). Complication rate did not differ significantly between groups (P = 0.056), although the incidence of significant pericardial effusion was higher in the MCN group (3 cases vs. 0 in RMN group).
  
  
  CONCLUSIONS
  Although in patients with persistent AF, the recurrence rate is higher in RMN group, the outcome is comparable between RMN and MCN groups in patients with paroxysmal AF. A multicentre prospective randomized study is warranted to clarify this issue.
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Koutalas
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Livio
authors.initials: L
authors.lastname: Bertagnolli
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Phillip
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Breithardt
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany dr.arasharya@gmail.com.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D062906:Cardiac Catheters; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D002404:Catheterization / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D059346:Magnets; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010490:Pericardial Effusion / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Remote magnetic navigation; Steerable sheath