Robotic magnetic navigation guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation, when compared to conventional techniques

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) is an important treatment option for patients with atrial fibrillation (AF). Pulmonary vein isolation (PVI) is a pivotal part of any AF ablative therapy. Currently, there are multiple techniques available to realize PVI, including: manual guided cryoballoon (MAN-CB), manual guided radiofrequency (MAN-RF) and Remote Magnetic Navigation guided RF ablation (RMN-RF). However, there is lack of large prospective trials comparing contemporary RMN-RF with the conventional CA techniques. Purpose This study prospectively analyzed and compared three catheter ablation techniques in patients with paroxysmal AF. Methods This multicenter, prospective study included patients with paroxysmal AF who underwent their first CA procedure with one of the mentioned ablation techniques. Procedural parameters (including procedural efficiency), complication rates and freedom of AF during 12-month follow-up were compared between three study groups defined by the utilized ablation technique. Results A total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN-CB (78±21 min) compared to MAN-RF (115±41 min) and compared to RMN-RF (129±32 min) (P<0.001), whereas it was comparable between the two RF groups. A 3% complication rate was observed which was comparable between all groups. At 12-month follow-up, we observed AF recurrence in 40 patients (19%). AF recurrence was significantly lower in the RMN-RF group (MAN-CB 19 (24%) AF recurrences, MAN-RF 16 (23%), RMN-RF 5 (8%), P=0.045; multivariate HR of RMN-RF on AF recurrence 0.32, 95%-CI 0,12–0.87, P=0.026; with MAN-CB + MAN-RF as the reference group). Conclusion RMN guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time efficient ablation technique, whereas RMN has comparable efficiency with manual RF ablation.