Remote Robotic Navigation and Electroanatomical Mapping for Ablation of Atrial Fibrillation – Considerations for Navigation and Impact on Procedural Outcome Short Title: Remote Robotic Navigation for AF Ablation

Background: Radiofrequency current (RFC) ablation of atrial fibrillation (AF) requires high technical skills to achieve optimal catheter stability and is associated with an individually high X-ray exposure to both the patient and the operator. In order to facilitate catheter navigation and to reduce the operator’s X-ray burden remote navigation (RN) systems have been developed. Considerations for navigation of a novel remote robotic navigation system in pulmonary vein isolation (PVI) procedures are reported. Methods and Results: In 65 patients with drug-refractory AF (43 paroxysmal, 22 persistent) complete circumferential PVI was performed using RN in conjunction with different electroanatomic mapping systems. Acute complete PVI using exclusively RN was achieved in 95%. The procedure time was 195 ± 40 min. The operator’s X-ray exposure time was reduced by 6 ± 4 min (35%) using RN. In 7/14 pts with persistent AF conversion to SR was achieved by RFC ablation. During a median follow-up period of 239 days (range 184-314 days) 47/65 patients (73%) remained free of any documented atrial tachyarrhythmia recurrences following a single procedure. The relative proportion of patients remaining free of AF was 76% and 68% for paroxysmal and persistent AF, respectively. Conclusions: PVI using the novel RN system can be performed safely and effectively. One third of the operator’s fluoroscopy exposure time might be saved using RN. However, the question, whether the overall fluoroscopy exposure is reduced by RN and if RN improves PVI procedures needs to be assessed during a comparative trial between man and machine.