A single center long-term comparison of remote magnetic navigation-assisted catheter ablation versus manual catheter ablation of atrial fibrillation

by Simon Schlögl
Doctoral thesis
Date of Examination:2024-12-18
Date of issue:2024-11-19
Advisor:Prof. Dr. Markus Zabel
Referee:Prof. Dr. Markus Zabel
Referee:PD Dr. Ulrich Krause
Persistent Address: http://dx.doi.org/10.53846/goediss-10884

 

 

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Abstract

English

Background: Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation (MCN) ablation of atrial fibrillation (AF) is lacking. The aim of the present study was to compare the outcome of RMN versus (vs.) MCN ablation of AF with regards to AF recurrence. Methods: The study comprised 667 consecutive patients with a total of 939 procedures: 287 patients were ablated using RMN, 380 using MCN. Results: There was no significant difference between the groups at baseline. After the follow-up, significantly more patients remained free of AF recurrence in the MCN group compared to the RMN group. After the procedure, there was a significant reduction in the AF burden by both groups, however the RMN patients had a significantly higher AF burden compared to the MCN group. After analysis of repeat ablations there was a significantly higher reconnection rate of pulmonary veins after RMN ablation. In multivariable Cox-regression analysis, RMN ablation was an independent risk factor for AF recurrence besides age, persistent AF, number of isolated pulmonary veins, and left atrial diameter. Procedure time, radiofrequency application time and total number of ablation points were higher in the RMN group. Total fluoroscopy time and total fluoroscopy dose were significantly lower for RMN. Complication rates did not differ between groups. We registered a significant learning curve effect by the MCN approach leading to faster ablations in the second half of the ablation group. Conclusions: In our study the AF recurrence rate and pulmonary vein reconnection rate is higher after RMN ablation with a similar complication rate.
Keywords: atrial fibrillation; catheter ablation; pulmonary vein ablation; remote magnetic navigation