Gagyi Rita B, Noten Anna M E, Wijchers Sip, Yap Sing-Chien, Bhagwandien Rohit E, Hoogendijk Mark G, Szili-Torok Tamas
Erasmus Medical Center, Rotterdam, the Netherlands.
Int J Cardiol Heart Vasc. 2022 Jul 21;42:101095. doi: 10.1016/j.ijcha.2022.101095. eCollection 2022 Oct.
Robotic magnetic navigation (RMN) provides increased catheter precision and stability. Formerly, only the CARTO 3 mapping system was integrated with the RMN system (CARTO-RMN). Recently, a novel high-resolution non-contact mapping system (AcQMap) has been integrated with the RMN system (AcQMap-RMN) for the treatment of atrial fibrillation (AF) and atrial tachycardias (AT). We aim to compare the safety, efficiency, and efficacy of AcQMap-RMN with CARTO-RMN guided catheter ablation (CA) procedures.
In this prospective registry, procedural safety efficiency and outcome data from total of 238 consecutive patients (147 AcQMap-RMN and 91 CARTO-RMN patients) were compared.
AcQMap-RMN is non-inferior in the primary endpoint of safety as compared to CARTO-RMN across the whole group (overall procedural complications in 5 (3.4%) vs. 3 (3.3%) patients, p = 1.0). Overall procedure durations were longer and associated with more fluoroscopy use with AcQMap-RMN (172.5 vs. 129.6 min, p < 0.01; 181.0 vs. 131.0 mGy, p = 0.02, respectively). Procedure duration and fluoroscopy use decreased significantly between the first 30 and the last 30 AcQMap-RMN procedures. The AcQMap-RMN system had fewer recurrences after persistent AF ablations and was non-inferior in paroxysmal AF patients compared to CARTO-RMN at 12 months (36.6% vs. 75.0%, p = 0.04, PAF 6.6% vs. 12.5%, p = 0.58; respectively). CA of AT outcomes were better using the AcQMap-RMN system (1 year recurrence 17.1% vs. 38.7%, p < 0.05).
AcQMap-RMN integration has no negative impact on the excellent safety profile of RMN guided ablations. It improves outcomes of CA procedures for persAF and AT but requires longer procedure times and higher fluoroscopy use during the initial learning phase.
机器人磁导航（RMN）可提高导管的精准度和稳定性。以前，只有CARTO 3标测系统与RMN系统整合（CARTO-RMN）。最近，一种新型高分辨率非接触标测系统（AcQMap）已与RMN系统整合（AcQMap-RMN）用于治疗心房颤动（AF）和房性心动过速（AT）。我们旨在比较AcQMap-RMN与CARTO-RMN指导下的导管消融（CA）手术的安全性、效率和疗效。
在这个前瞻性登记研究中，比较了连续238例患者（147例AcQMap-RMN患者和91例CARTO-RMN患者）的手术安全性、效率和结果数据。
在整个组中，AcQMap-RMN在安全性的主要终点方面不劣于CARTO-RMN（5例（3.4%）与3例（3.3%）患者出现总体手术并发症，p = 1.0）。AcQMap-RMN的总体手术时间更长，且使用的透视时间更多（分别为172.5分钟对129.6分钟，p < 0.01；181.0 mGy对131.0 mGy，p = 0.02）。在最初的30例和最后的30例AcQMap-RMN手术之间，手术时间和透视使用量显著减少。与CARTO-RMN相比，AcQMap-RMN系统在持续性AF消融后复发较少，在阵发性AF患者中12个月时不劣（分别为36.6%对75.0%，p = 0.04；PAF为6.6%对12.5%，p = 0.58）。使用AcQMap-RMN系统进行AT消融的结果更好（1年复发率为17.1%对38.7%，p < 0.05）。
AcQMap-RMN整合对RMN指导下消融的卓越安全性没有负面影响。它改善了持续性AF和AT的CA手术结果，但在初始学习阶段需要更长的手术时间和更多的透视使用量。
