Gagyi Rita B, Minciuna Ioan A, Geczy Tamas, Nemes Attila, Szili-Torok Tamas
Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary.
5th Department of Internal Medicine, Faculty of Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Interv Card Electrophysiol. 2025 Jun 4. doi: 10.1007/s10840-025-02058-z.
Early reports on pulmonary vein isolation (PVI) for atrial fibrillation (AF) guided by robotic magnetic navigation (RMN) show comparable results to manual radiofrequency (RF) or cryoballoon ablation; however, lengthy procedures were reported. This could be due to suboptimal lesion formation caused by a lack of user experience and defined best practices. Operators performed RMN-guided RF ablation with lower power settings, presumably leading to longer procedures. In this study, we aimed to re-evaluate safety and efficiency of RMN-guided PVI for AF based on delivered radiofrequency power.
Patients undergoing RMN-guided ablation were screened, and consecutive patients with AF undergoing PVI-only between 2008 and 2023 were retrospectively enrolled. Patients were grouped by the power settings utilized during the PVI procedure (group 1-25-30W, group 2-30-35W, group 3-35-40W, group 4-40-45W, group 5-45-50W, and group 6-50-55W). We collected and analyzed demographic data: age, sex, and AF type; safety data: intra- and post-procedural complications; procedural data: procedure duration, fluoroscopy time, RF ablation time, RF application number, and success rate; and follow-up data: AF recurrence and number of redo procedures.
From the total number of 3398 screened patients, 238 patients met the inclusion criterion of undergoing PVI-only procedure (mean age 60.4 ± 9.9 years, 63.8% male). Throughout the 15 years only five patients had major (2.2%) and 15 patients had minor complications (6.6%), without differences between the patient groups (p = 0.40 and p = 0.63). The mean procedure duration was progressively decreased with the use of higher RF power (273.9 ± 97.0, 179.8 ± 104.0, 134.9 ± 55.3, 134.0 ± 39.5, 118.1 ± 41.3, and 110.9 ± 39.0 min, respectively; p < 0.001). Median fluoroscopy time was 19.5 min (IQR 13.0-35.5), progressively decreasing within the power groups (58.2 ± 20.5, 40.5 ± 26.2, 15.9 ± 6.6, 17.8 ± 8.1, 17.4 ± 7.5, and 19.8 ± 9.3 min; p < 0.001). We found differences between the power groups in RF application number (p < 0.001) and RF application duration (p = 0.003). Successful PVI was achieved in 238 patients (100.0%). Twenty-one patients with paroxysmal AF (17.1%) and 31 patients with persistent AF (40.7%) had documented recurrence during the 12-month follow-up. We found no differences in AF recurrence between the patient groups (p = 0.18 and 0.66).
RMN-guided PVI-only for AF is safe and feasible. In contrast to early reports, procedure times and fluoroscopy use gradually decreased during the years, when increasing RF power was applied. Higher power settings during robotically-guided PVI did not compromise the safety of the procedures.
早期关于机器人磁导航（RMN）引导下肺静脉隔离（PVI）治疗心房颤动（AF）的报告显示，其结果与手动射频（RF）或冷冻球囊消融相当；然而，报告称手术时间较长。这可能是由于缺乏用户经验和明确的最佳实践导致病变形成不理想。操作者在RMN引导下进行RF消融时使用较低的功率设置，可能导致手术时间延长。在本研究中，我们旨在基于输送的射频功率重新评估RMN引导下AF的PVI的安全性和效率。
对接受RMN引导消融的患者进行筛查，并回顾性纳入2008年至2023年间仅接受PVI的连续AF患者。根据PVI手术期间使用的功率设置对患者进行分组（第1组 - 25 - 30W，第2组 - 30 - 35W，第3组 - 35 - 40W，第4组 - 40 - 45W，第5组 - 45 - 50W，第6组 - 50 - 55W）。我们收集并分析了人口统计学数据：年龄、性别和AF类型；安全性数据：手术中和手术后的并发症；手术数据：手术持续时间、透视时间、RF消融时间、RF应用次数和成功率；以及随访数据：AF复发和再次手术次数。
在总共3398例筛查患者中，238例符合仅接受PVI手术的纳入标准（平均年龄60.4±9.9岁，男性占63.8%）。在这15年中，仅5例患者发生主要并发症（2.2%），15例患者发生轻微并发症（6.6%），各患者组之间无差异（p = 0.40和p =
