Comparison Between Efficacy and Safety of Remote Magnetic Navigation and Manual Catheter Navigation for Atrial Fibrillation Ablation: An Updated Meta-analysis and Systematic Review.

Abstract

Atrial fibrillation (AF) ablation is a common treatment for symptomatic AF. Remote magnetic navigation (RMN) and manual catheter navigation (MCN) are two predominant techniques employed in this procedure, each with advantages and limitations. This meta-analysis compares the efficacy, safety, and procedural outcomes of RMN versus MCN for AF ablation. A comprehensive search was conducted across PubMed, Google Scholar, and Embase to identify relevant studies comparing RMN and MCN for AF ablation. Statistical pooling was done using Review Manager 5.4.1 (Cochrane Collaboration, London, UK). The Newcastle-Ottawa scale was used for the evaluation of bias in observational studies. We evaluated the robustness of the evidence following the guidelines outlined by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. The primary outcomes of the study included freedom from AF, procedure time, fluoroscopy time, and total complication rate in patients undergoing AF ablation either using the RMN or MCN technique. A total of 22 studies involving 5361 patients were included in the meta-analysis. The pooled analysis demonstrated comparable freedom from AF between RMN and MCN (relative risk [RR], 0.94; 95% confidence interval [CI], 0.84-1.04; P = .23). However, RMN was associated with a significantly prolonged procedure duration (mean difference [MD], 48.58; 95% CI, 31.49-65.66; P < .00001) and reduced fluoroscopy time (MD, -12.52; 95% CI, -17.84 to -7.20; P < .00001) compared to MCN. Additionally, RMN showed a trend toward lower total complication rates (RR, 0.63; 95% CI, 0.45-0.88; P = .007). In AF ablation, RMN and MCN exhibit comparable efficacy in achieving freedom from AF. However, RMN is associated with a prolonged procedure duration compared to MCN. Nonetheless, RMN offers advantages in terms of reduced fluoroscopy times and lower total complication rates, highlighting its potential for improving procedural safety. The choice between RMN and MCN should be made considering individual patient factors and procedural objectives.