Abstract 4654: Robotic Navigation for Ablation of Atrial Fibrillation: Largest Single Center Experience
Radiofrequency ablation of atrial fibrillation requires precise catheter manipulation and stability for safe application of effective lesion sets. Robotic navigation of ablation catheters offers the potential for enhanced control and more consistent tissue contact, while reducing radiation exposure and fatigue to the operator. We present the largest single center experience of robotic ablation catheter navigation to date. Remote atrial fibrillation ablation was performed utilizing a robotic catheter navigation system (Hansen Medical, Inc., Mountain View, CA). Ablation lesion sets consisted of pulmonary vein antral isolation (PVAI) and posterior left atrial (LA) wall isolation in all patients; additional lesions targeting complex fractionated electrograms, along with mitral annular/LA roof lesions, coronary sinus isolation, and right atrial ablation was performed as necessary. Primary endpoints were acute success of PVAI, fluoroscopy/procedure times, 6-month efficacy (after a 3-month blanking period), and procedural complications. 162 patients underwent mapping and ablation of atrial fibrillation utilizing the robotic navigation system (106 paroxysmal, 56 persistent/chronic). The primary endpoint of successful PVAI of all veins was achieved in every patient. Mean fluoroscopy and procedure times declined significantly during the study period (53.8 minutes fluoro for first 50 cases vs. 38.3 minutes for subsequent procedures; 188.2 minutes procedure time for first 50 cases vs. 163.6 minutes for subsequent procedures). Of patients reaching 6 month follow-up, 16/17 (94%) PAF patients were free of AF, as were 13/15 ( 87%) patients with CAF. Major adverse events occurred in 3 patients (2 pericardial tamponade, 1 femoral pseudoaneurysm); all recovered without adverse sequelae. These preliminary results indicate that robotic navigation of catheters for ablation of atrial fibrillation is safe and effective, and that fluoroscopy and procedure times decrease with experience. Complication rates are consistent with those reported for manual ablation. 6-month efficacy is encouraging, but a larger patient cohort with longer follow-up will be required to draw definitive conclusions.