Utilization of steerable sheath improves the efficiency of atrial fibrillation ablation guided by robotic magnetic navigation compared with fixed-curve sheath

Background The objective of this study was to assess the impact of steerable sheaths compared with fixed-curve sheaths on the procedural outcomes of atrial fibrillation (AF) ablation guided by robotic magnetic navigation (RMN). Methods and Results In this retrospective case-control study, 110 patients scheduled for AF catheter ablation were enrolled and divided into two groups. Fifty-five patients (paroxysmal, 70%) were treated with RMN-guided ablation utilizing a steerable sheath and another 55 patients (paroxysmal, 70%) were ablated with RMN using a fixed-curve sheath. Clinical characteristics were similar between the two groups. Compared with the fixed-curve sheath group, the steerable sheath group procedure time (111.9 +/- 25.2 vs. 90.4 +/- 20.7 min, p < .001) and radiofrequency (RF) time (35.9 +/- 9.0 vs. 30.5 +/- 7.4 min, p < .001) were significantly shortened. Additionally, the navigation index was significantly improved (0.41 +/- 0.06 vs. 0.48 +/- 0.08, p < .001) in the steerable sheath group. By employing a large catheter loop for targeting the right pulmonary veins (PVs), the steerable sheath group significantly reduced the RF delivery time (15.0 +/- 3.0 vs. 12.0 +/- 2.1 min, p < .001) during right-side PV isolation (PVI). However, total fluoroscopy time was similar between the two groups (5.6 +/- 2.6 vs. 5.0 +/- 2.0 min, p > .05). Acute PVI success rates were similar between the two groups. No major or minor complications occurred in either group. Conclusion Appropriate utilization of steerable sheath technology can improve the efficiency of AF ablation guided by RMN, primarily by reducing the total procedure and RF delivery times of right-side PVI without compromising safety.