Manual Ablation vs Robotic Navigation for Afib Pulmonary Vein Isolation

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.

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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