Abstract
Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN (p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure.
Highlights
Percutaneous pulmonary vein isolation (PVI) has become an established treatment for patients with drug-refractory, paroxysmal atrial fibrillation (AF) [1]
We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN)
Drugresistant, paroxysmal AF who underwent a first PVI via point-by-point RF ablation with an open-irrigated catheter between 1 January 2010 and 31 August 2012 were included in this retrospective study
Summary
Percutaneous pulmonary vein isolation (PVI) has become an established treatment for patients with drug-refractory, paroxysmal atrial fibrillation (AF) [1]. PVI is performed by manual (MAN) point-by-point radiofrequency (RF) ablation. Ablation via remote navigation systems is an alternative strategy to perform point-by-point PVI. Various remote navigation systems available today can be divided into two categories: electromagnetic systems (NIOBE6/EPOCH6, Stereotaxis Inc., and GCI navigation system, Magnetics Inc.) and the electromechanical systems (Sensei, Hansen Medical Inc., and Amigo, Catheter Robotics Inc.). Most clinical data available is with remote magnetic navigation (RMN) via the NIOBE/EPOCH navigation system. Potential benefits of the RMN include operator’s comfort, reduced radiation exposure for both operator and patient, and improved safety of the procedure due to precision of catheter movement, soft tip, and the stability of the catheter. Stability of the catheter during ablation may lead to stable and effective lesions and better outcome
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