title: Safety and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity-Score Analysis.
abstract: BACKGROUND
  Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered.
  
  
  RESULTS
  In this observational registry study, we used propensity-score matching to compare the outcomes of patients with symptomatic drug-refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3-month blanking period. At a mean follow-up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63-1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001).
  
  
  CONCLUSIONS
  In this propensity-score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times.
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Pedro Pulido
authors.initials: PP
authors.lastname: Adragão
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Cavaco
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: António Miguel
authors.initials: AM
authors.lastname: Ferreira
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Francisco Moscoso
authors.initials: FM
authors.lastname: Costa
authors.affiliation: Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Parreira
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Carmo
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Francisco Bello
authors.initials: FB
authors.lastname: Morgado
authors.affiliation: Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Katya Reis
authors.initials: KR
authors.lastname: Santos
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Pedro Galvão
authors.initials: PG
authors.lastname: Santos
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.
authors.forename: Anai
authors.initials: A
authors.lastname: Durazzo
authors.affiliation: Cardiovascular Imaging Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Pedro Araújo
authors.initials: PA
authors.lastname: Gonçalves
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.|Cardiology Department, Hospital da Luz, Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.affiliation: Cardiology Department, Hospital Santa Cruz, Western Lisbon Hospital Center, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D060328:Magnetic Phenomena; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D057216:Propensity Score; D012042:Registries; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; efficacy; magnetic navigation system; manual ablation; propensity score; safety