Manual Ablation vs Robotic Navigation for Afib Pulmonary Vein Isolation

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One patient in the robotic navigation group developed a fatal esophageal fistula.
One patient in the robotic navigation group developed a fatal esophageal fistula.

HealthDay News — For patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein isolation (CPVI), use of robotic navigation (RN) systems is noninferior to manual ablation (MN), according to a study published online in JACC: Clinical Electrophysiology.

Andreas Rillig, MD, from Asklepios Klinik St. Georg in Hamburg, Germany, and colleagues examined the efficacy and safety of CPVI using RN systems vs MN in a prospective trial involving 258 patients with paroxysmal or persistent AF. Participants were randomized to CPVI with either RN (n=131) or MN (n=127). CPVI was performed using irrigated radiofrequency ablation in combination with a 3D mapping system in all patients.

The researchers found that the MN-group had significantly shorter procedure time (129.3±43.1 vs 140.9±36.5 minutes; P =.026). Overall, 123 patients from the RN group and 124 from the MN group completed the 12-month follow-up. The rate of recurrence was comparable between the RN and MN groups (23.6% and 20.2%, respectively). There was no significant difference between the groups in terms of the incidence of procedure-related major complications (6.1% and 4.7% in the RN and MN groups, respectively; P =.62). A fatal atrio-esophageal fistula developed in one patient from the RN group.

"This study demonstrated that robotic ablation is noninferior to the current gold-standard of manual ablation for CPVI with respect to success and complication rates," the authors wrote.

Disclosures: Several authors disclosed financial ties to pharmaceutical and medical device companies, including St. Jude Medical and Hansen Medical, which partially supported the study.


Rillig A, Schmidt B, Di Biase L, et al. Manual vs robotic catheter ablation for the treatment of atrial fibrillation. The man and machine trial [published online June 26, 2017]. JACC Clin Electrophysiol. doi:10.1016/j.jacep.2017.01.024

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