title: Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation.
abstract: OBJECTIVE
  The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation.
  
  
  RESULTS
  Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN-RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN-CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027).
  
  
  CONCLUSIONS
  The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced.
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco a.errahmouni@gmail.com.
authors: Abdelkarim
authors: A
authors: Errahmouni
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco.
authors: Decebal Gabriel
authors: DG
authors: Latcu
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco.
authors: Sok-Sithikun
authors: SS
authors: Bun
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco.
authors: Nicolas
authors: N
authors: Rijo
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco.
authors: Céline
authors: C
authors: Dugourd
authors: Cardiologie, Centre Hospitalier Princesse Grace, Avenue Pasteur 98000, Monaco.
authors: Nadir
authors: N
authors: Saoudi
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D017115:Catheter Ablation / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D008280:Magnetics / Q000295:instrumentation*; D008328:Man-Machine Systems; D008875:Middle Aged; D065287:Robotic Surgical Procedures / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Magnetic navigation; Robotic sheath