Radiofrequency atrial fibrillation ablation with irrigated tip catheter using remote magnetic navigation compared with conventional manual method

• Published in: Journal of interventional cardiac electrophysiology Vol. 62; no. 1; pp. 95 - 102
• Main Authors: Ghadban, Rugheed, Gifft, Kristina, Luebbering, Zachary, Sodhi, Sandeep, Cooper, Daniel, Enezate, Tariq
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2021; Springer Nature B.V
• Subjects: Ablation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Catheter Ablation; Catheters; Clinical outcomes; Clinical trials; Complications; Fibrillation; Fluoroscopy; Humans; Magnetic Phenomena; Medical instruments; Medicine; Medicine & Public Health; Radio frequency; Safety; Treatment Outcome; And outcomes; Remote magnetic navigation; Manual catheter navigation; Ablation; Atrial fibrillation
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-020-00879-8

Background
Studies comparing manual catheter navigation (MCN) to remote magnetic navigation (RMN) for atrial fibrillation (AF) ablation showed variable results.
Objective
The aim of this meta-analysis is to compare the safety and clinical outcomes of AF radiofrequency (RF) ablation using MCN versus RMN with irrigated tip catheters.
Methods
Medline and the Cochrane Central Register of Controlled Trials (CENTRAL) were queried from inception through January 2019. Studies comparing safety and clinical outcomes of AF ablation with RF using MCN versus RMN with irrigated tip catheters were included. Random effects meta-analysis was used to pool outcomes across studies. Study endpoints included freedom of AF at the end of the study, procedure total time, fluoroscopy time, and complications.
Results
A total of 14 studies (3 controlled non-randomized trials, 1 prospective observational, and 10 retrospective observational studies) involving 3375 patients (1871 in MCN and 1504 in RMN) were included in this meta-analysis. There was no significant difference between the two groups in terms of freedom of AF (OR 1.08, 95% CI 0.82–1.42,
p
 = 0.52). The MCN group was associated with shorter procedure time (mean difference in minutes − 50.39, 95% CI − 67.99 to − 32.79,
p
 < 0.01), longer fluoroscopy time (mean difference in minutes 18.01, 95% CI 10.73–25.29,
p
 < 0.01), and higher complication rate (OR 2.18, 95% CI 1.24–3.82,
p
 < 0.01).
Conclusions
AF ablation utilizing MCN was associated with similar efficacy to RMN but with higher complication rates. Although the procedure time was shorter with MCN, the fluoroscopy time was more prolonged. Randomized clinical studies are needed to further verify these results.