Substantial superiority of Niobe ES over Niobe II system in remote-controlled magnetic pulmonary vein isolation

Abstract Background Catheter ablation of atrial fibrillation (AFib) primarily relies upon pulmonary vein isolation (PVI), but such procedures are associated with significant X-ray exposure. The newer Epoch system has been developed so as to enable more precise magnetic navigation while limiting X-ray exposure. Objectives This study was aimed at quantifying both exposure time and X-ray reduction with the newer Epoch system compared to Niobe II during AFib ablation procedures. Methods From November 2011 to November 2013, our last 92 consecutive patients treated with the Niobe ES (Epoch Solution; 4th-generation magnetic navigation technology) system were compared with the first 92 consecutive patients treated using the Niobe II system (3rd-generation magnetic navigation technology) for symptomatic drug-refractory AFib. Results Mean patient age was 59 ± 11 years (20% female), and the study population was affected by either symptomatic paroxysmal (65.2%) or persistent (34.8%) AFib. Median procedure time was 2 ± 0.5 h and median total X-ray exposure 12.3 ± 6.4 min. Procedure time (1.9 ± 0.4 vs. 2.7 ± 1 h, p < 0.0001) and X-ray duration (12 ± 4 vs. 15 ± 7 min, p = 0.001) were significantly lower with Niobe ES than with the Niobe II system. X-ray ablation exposure time was also significantly lower with the Niobe ES system than with the Niobe II system (2.9 ± 2 vs. 4 ± 3.5 min; p = 0.01). Through multivariate analysis, the only predictive factors influencing both procedure duration and X-ray exposure were found to be the Niobe ES system use and LA size. Conclusions Our study was the first to demonstrate that the new Niobe ES magnetic robotic system substantially reduced overall operating, fluoroscopy, and ablation times during AFib ablation procedure.