title: A randomized prospective mechanistic cardiac magnetic resonance study correlating catheter stability, late gadolinium enhancement and 3 year clinical outcomes in robotically assisted vs. standard catheter ablation.
abstract: OBJECTIVE
  To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes.
  
  
  RESULTS
  Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%.
  
  
  CONCLUSIONS
  Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures.
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK aruna.arujuna@kcl.ac.uk.
authors: Aruna
authors: A
authors: Arujuna
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
authors: Rashed
authors: R
authors: Karim
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
authors: Niloufar
authors: N
authors: Zarinabad
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
authors: Jaspal
authors: J
authors: Gill
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
authors: Kawal
authors: K
authors: Rhode
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK.
authors: Tobias
authors: T
authors: Schaeffter
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: Matthew
authors: M
authors: Wright
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: C Aldo
authors: CA
authors: Rinaldi
authors: Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: Michael
authors: M
authors: Cooklin
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: Reza
authors: R
authors: Razavi
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: Mark D
authors: MD
authors: O'Neill
authors: Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, UK Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors: Jaswinder S
authors: JS
authors: Gill
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D008137:Longitudinal Studies; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Atrial fibrillation; Cardiac magnetic resonance imaging; Catheter ablation; Long-term follow-up; Pulmonary vein isolation; Robotic-assisted