Mitral Isthmus Ablation is Feasible, Efficacious, and Safe Using a Remote Robotic Catheter System

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.