Department of Electrophysiology, Heart Center University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Department of Cardiology, University Hospital, Heidelberg, Germany.
Clin Res Cardiol. 2019 Mar;108(3):298-308. doi: 10.1007/s00392-018-1356-6. Epub 2018 Aug 29.
Robotic (RNS) or magnetic navigation systems (MNS) are available for remotely performed catheter ablation for atrial fibrillation (AF).
The present study compares remotely assisted catheter navigation (RAN) to standard manual navigation (SMN) and both systems amongst each other.
The analysis is based on a sub-cohort enrolled by five hospitals from the multicenter German ablation Registry.
Out of 2442 patients receiving catheter ablation of AF, 267 (age 61.4 ± 10.4, 69.7% male) were treated using RAN (RNS n = 187, 7.7% vs. MNS n = 80, 3.3%). Fluoroscopy time [RNS median 17 (IQR 12-25) min vs. MNS 22 (16-32) min; p < 0.001] and procedure duration [RNS 180 (145-220) min vs. MNS 265 (210-305) min; p < 0.001] were significantly different. Comparing RAN (11%) to SMN (89%) fluoroscopy time (RAN 19 (13-27) min, vs. SMN 25 (16-40) min; p < 0.001), energy delivery (RAN 3168 (2280-3840) s vs. SMN 2640 (IQR 1799-3900) s; p = 0.008) and procedure duration [RAN 195 (150-255) min vs. SMN 150 (120-150) min; p = 0.001] differed significantly. In terms of acute and 12 months outcome, no differences were seen between the two systems or in comparison to SMN.
AF ablation can be performed safely, with high acute success rates using RAN. RNS results in less fluoroscopy burden and shorter procedure durations. Compared to SMN, a reduced fluoroscopy burden, prolonged procedure and ablation duration were observed using RAN. Overall, the number of RAN procedures is small suggesting low impact on clinical routine of AF ablation.
机器人（RNS）或磁导航系统（MNS）可用于远程执行心房颤动（AF）的导管消融。
本研究比较了远程辅助导管导航（RAN）与标准手动导航（SMN）以及两种系统之间的比较。
该分析基于来自多中心德国消融登记处的五家医院招募的亚队列。
在接受 AF 导管消融的 2442 名患者中，267 名（年龄 61.4±10.4，69.7%为男性）接受 RAN 治疗（RNS 组 187 名，7.7% vs. MNS 组 80 名，3.3%）。透视时间[RNS 中位数 17（IQR 12-25）min vs. MNS 22（16-32）min；p<0.001]和手术时间[RNS 180（145-220）min vs. MNS 265（210-305）min；p<0.001]差异显著。与 SMN（89%）相比，RAN（11%）的透视时间（RAN 19（13-27）min，vs. SMN 25（16-40）min；p<0.001）、能量传递（RAN 3168（2280-3840）s vs. SMN 2640（IQR 1799-3900）s；p=0.008）和手术时间[RAN 195（150-255）min vs. SMN 150（120-150）min；p=0.001]差异显著。在急性和 12 个月的结果方面，两种系统之间或与 SMN 相比，没有差异。
使用 RAN 可以安全地进行 AF 消融，具有较高的急性成功率。RNS 透视时间较短，手术时间较短。与 SMN 相比，使用 RAN 可减少透视时间、延长手术和消融时间。总体而言，RAN 手术数量较少，提示对 AF 消融临床常规的影响较小。
