Robotically assisted ablation of atrial fibrillation: a systematic review and meta-analysis

Abstract

Background: Robotic systems are becoming increasingly common in complex ablation procedures. We conducted systematic review and meta-analysis on the procedural outcomes of Magnetic Navigation System (MNS) in comparison to conventional catheter navigation for atrial fibrillation (AF) ablation.

Methods: An electronic search was performed using multiple databases between 2002 & 2012. Outcomes were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times.

Results: Fifteen studies (11 nonrandomized controlled studies & 4 case series) involving 1647 adult patients were identified. In comparison between MNS and conventional groups, a tendency towards higher acute success was noted with conventional group but with similar long-term freedom from AF (95% vs. 97%, odds ratio (OR) 0.25 (95% confidence interval [CI] 0.06; 1.04, p=0.057); 73% vs. 75%, OR 0.92 (95% CI 0.69; 1.24, p=0.59), respectively). A significantly shorter fluoroscopic time was achieved with MNS (57 vs. 86 min, standardized difference in means (SDM) -0.90 (95% CI -1.68; -0.12, p=0.024)). Longer total procedure and ablation times were noted with MNS (286 vs. 228 min, SDM 0.7 (95% CI 0.28; 1.12, p=0.001); 67 vs. 47 min, SDM 0.79 (95% CI 0.18; 1.4, p=0.012), respectively). Overall complication rate was similar (2% vs. 5%, OR 0.48 (95% CI 0.18; 1.26, p=0.135)), however rate of significant pericardial complication defined either as tamponade or effusion requiring intervention/hospitalization was significantly lower in MNS (0.3% vs. 2.5%, p=0.005).

Conclusions: Our results suggest that MNS has similar rates of success and possibly superior safety outcomes when compared to conventional manual catheter ablation for AF.

Keywords: Atrial fibrillation; Catheter ablation; Efficacy & safety; Magnetic navigation system.