An international multicentre registry evaluating the role of remote robotic navigation and contact force sensing in persistent atrial fibrillation (AF) treatment has found that, at one year, a higher proportion of patients treated with this modality were free from AF recurrences with a single procedure as compared with both manual/contact force sensing and robotic/no contact force sensing procedures.
The study also found that the combination of contact force sensing with robotic navigation procedures is associated with lower fluoroscopy times compared with manual ablation.
Results of the registry authored by Waqas Ullah (Cardiology Research Department, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK) and others were published recently in the journal Pacing and Clinical Electrophysiology.
For the registry, Ullah et al included data from prospective registries from three groups based in six centres in the United Kingdom and South Africa. In total, 100 consecutive patients who underwent their first catheter ablation for persistent atrial fibrillation by February 2013 were analysed. Fifty patients underwent manual/contact force sensing ablation with the ThermoCool SmartTouch catheter (Biosense Webster) and 50 patients had contact force sensing ablation with the same device plus remote robotic navigation using the Sensei Robotic Catheter System (Hansen Medical). The authors note that historical control non-contact force sensing ablation patients were matched by propensity score, giving a total 200 patient cohort.
Ullah et al report that remote robotic navigation in combination with contact force sensing was associated with improved single procedure success at one year follow-up (64% vs 36%, p=0.01) and shorter fluoroscopy times (41% reduction, p<0.0005) than manual contact force sensing ablation without any difference in procedure times. They also report that compared with non-contact force sensing historical controls, patients treated using contact force sensing catheters had higher success rates for remote robotic navigation (64% vs 36%, p=0.01) but not manual ablation (36% vs 38%, p=1). The authors also report that there were no significant differences between groups in terms of complications.
Ullah et al conclude that “these findings, if confirmed in randomised trials, suggest that contact force sensing and remote robotic navigation may represent a synergistic combination of technologies for persistent atrial fibrillation ablation.”
In an accompanying editorial, Jesus Almendral (Electrophysiology Laboratory and Arrhythmia Unit, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain) considers that two of the most important developments in recent years in relation to radiofrequency ablation of atrial fibrillation are robotic catheter navigation and contact force measurement. He writes: “Theoretically speaking, the association of the stability provided by a robotically driven catheter and the assurance of good contact force provided by catheters that measure contact force is probably the best combination to ensure the physical conditions that can produce and adequate lesion […] In this context, the study by Ullah et al, in this issue of the Journal, could be particularly relevant.”
Almendral also raises questions on the results of this study regarding the superiority of robotic navigation with catheters with contact force sensing over other forms of point-by-point radiofrequency ablation for atrial fibrillation patients. He says that this is not a randomised study, there is also no information about operators experience and that it might be the case that more experienced operators were more familiar with the robotic system and their patients were more often assigned to the robotic arm, therefore resulting in better results. He also notes that there is not certainty as to what extent these results could apply to paroxysmal atrial fibrillation. However, he acknowledges that “Ullah et al should be congratulated for having detected a technological combination that could be clinically superior to what is the present time the most frequently used technology for catheter ablation of atrial fibrillation and also for being able to show clinical results that suggest a substantial benefit for the patients.”