Mitral isthmus ablation is feasible, efficacious, and safe using a remote robotic catheter system.
Wong KCK., Jones M., Webb T., Qureshi N., Bashir Y., Betts TR., Rajappan K.
BACKGROUND: There are limited data on the use of a remote robotic catheter system (RCS) for mitral isthmus (MI) ablation. METHODS: This single-center, prospective, matched control study included 45 patients who underwent atrial fibrillation ablation using a remote RCS compared to 45 patients who underwent conventional ablation. All patients had circumferential pulmonary vein isolation (PVI), roof, and MI ablation. RESULTS: There were no significant differences in baseline clinical characteristics. There were no significant differences in MI block (RCS: 44/45 [98%] vs CONTROL: 43/45 [96%], P = 1.0), roof block (RCS: 45/45 [100%] vs CONTROL: 44/45 [98%], P = 1.0), and PVI (RCS: 45/45 [100%] vs CONTROL: 45/45 [100%], P = 1.0). Ablation and procedural times were similar in both arms. Using RCS, mean total MI ablation and procedure times were 13 ± 6 minutes and 23 ± 15 minutes, respectively. Coronary sinus (CS) ablation was significantly less in the RCS arm (48% vs 72%, P = 0.03). It was possible to "drive" the ablation catheter into the distal CS using the RCS in 19/22 (86%) patients. There was a significant trend of reduction in mean MI ablation (P = 0.008) and procedural times (P = 0.004) over the course of the study period. There was a significant reduction in fluoroscopy time in the RNS arm (33 ± 17 minutes vs 49 ± 20 minutes, P = 0.0004). CONCLUSION: It is feasible and safe to use a remote RCS for MI ablation, including "driving into the CS." MI block was achieved in 98% with a significant reduction in the need for CS ablation (48%). There is a short learning curve.