Robotic remote catheter navigation for atrial fibrillation ablation a single center experience

Objectives: There continues to be interest in use of robotic remote catheter navigation (RCN) in electrophysiology procedures. We describe our experience with RCN to perform radiofrequency ablation of atrial fibrillation (AF). Methods: We reviewed cases receiving RCN AF ablation and compared them to manual control navigation (MCN) procedures performed in the same time period by the same operator. Outcomes were followed through 24 months. Results: In a 2-year period, 70 and 45 patients received their initial RCN or MCN AF ablation, respectively. There were no significant differences in baseline clinical characteristics between patients receiving RCN or MCN. Among RCN patients, EF was lower and left atrial diameter larger in patients with persistent AF (48.7 ± 10.9% and 52 ± 5 mm vs 55.2 ± 6.6% and 45 ± 10 mm, p = 0.004 and p < 0.0001, respectively). Total laboratory time was longer for RCN (380 ± 66 vs 350 ± 66.1 minutes, p = 0.019) while fluoroscopy time was shorter (20.7 ± 9.3 vs 24.8 ± 11.2 minutes, p = 0.04). Three patients in RCN group and none in the MCN group had postoperative complications (p = 0.28). By the end of twoyear follow-up patients who received RCN were more likely to be free from AF (54 [70%] vs 22 [47%], p = 0.002). There was a trend toward increased utilization of atrioventricular node ablation among MCN patients (4 [9%] vs 1 [1%], p = 0.06). Conclusions: RCN AF ablation was associated with increased laboratory and ablation times but decreased fluoroscopy times. RCN was associated with higher rates of sinus rhythm maintenance at 24 months.