Safety and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity-Score Analysis

• Published in: Journal of cardiovascular electrophysiology Vol. 27; no. S1; pp. S11 - S16
• Main Authors: ADRAGÃO, PEDRO PULIDO, CAVACO, DIOGO, FERREIRA, ANTÓNIO MIGUEL, COSTA, FRANCISCO MOSCOSO, PARREIRA, LEONOR, CARMO, PEDRO, MORGADO, FRANCISCO BELLO, SANTOS, KATYA REIS, SANTOS, PEDRO GALVÃO, CARVALHO, MARIA SALOMÉ, DURAZZO, ANAI, MARQUES, HUGO, GONÇALVES, PEDRO ARAÚJO, RAPOSO, LUÍS, MENDES, MIGUEL
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2016; Wiley Subscription Services, Inc
• Subjects: Aged; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; catheter ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheter Ablation - mortality; efficacy; Female; Follow-Up Studies; Humans; magnetic navigation system; Magnetic Phenomena; Male; manual ablation; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - mortality; Propensity Score; Registries; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - mortality; safety; Survival Rate; Treatment Outcome; magnetic navigation system; atrial fibrillation; manual ablation; safety; catheter ablation; efficacy; propensity score
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.12900

Magnetic versus Manual Ablation of Atrial Fibrillation Introduction Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered. Methods and Results In this observational registry study, we used propensity‐score matching to compare the outcomes of patients with symptomatic drug‐refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3‐month blanking period. At a mean follow‐up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63–1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001). Conclusions In this propensity‐score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times.