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

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. (C) 2013 Elsevier Ireland Ltd. All rights reserved.