COMPARISON OF ATRIAL FIBRILLATION ABLATION EFFICACY USING REMOTE MAGNETIC NAVIGATION VS. MANUAL NAVIGATION WITH CONTACT-FORCE CONTROL

Aim: This study was designed to compare the clinical utility and mid-term outcomes of remote magnetic navigation (RMN)- and manual navigation (MAN)-guided radiofrequency ablation (RFA) for paroxysmal and persistent atrial fibrillation.

Methods: We retrospectively enrolled 146 patients diagnosed with symptomatic, drug-resistant, paroxysmal or persistent atrial fibrillation (AF). In the RMN group (n=57), patients were treated with the Carto 3 mapping system in combination with the remote navigation system Stereotaxis Niobe ES and standard irrigated ablation catheter. In the MAN group (n=89), ablation was performed with the EnSite Velocity mapping system and a TactiCath™ Quartz catheter with direct contact force measurement. Procedural time, ablation time, fluoroscopy time, radiation dose and ablation counts were measured and compared between the groups. Recurrence of AF was evaluated after 6 months of follow-up.

Results: Mean procedure times (236.87±64.31 vs. 147.22±45.19 min., p<0.05), counts of RF applications (74.30±24.77 vs. 49.15±20.33, p<0.05) and total RFA times (4323.39±1426.69 vs. 2780.53±1157.85 sec., p<0.05) were all significantly higher in the RMN than in the MAN group. Mean X-ray dose (9722.6±7507.4 vs. 8087.9±6051.5 mGy/cm2, p=0.12) and mean total X-ray exposure time (8.07±4.20 vs. 9.54±5.47 min., p=0.08) were comparable. After 6 months of follow-up, freedom from AF was similar in the RMN and MAN groups for paroxysmal (60.8% and 73%, respectively, p=0.42) and persistent AF (69.6% and 75.0%, respectively, p=0.77).

Conclusions: Through comparison with remote magnetic navigation, manual ablation of atrial fibrillation was demonstrated to produce more favorable results with respect to acute procedural parameters. Mid-term outcomes were similar in both groups.