Very Long-term Outcomes of Remote Magnetic Navigation-guided Catheter Ablation in Patients with Advanced Persistent Atrial Fibrillation
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Abstract
Background: Remote magnetic navigation (RMN) enables precise three-dimensional catheter control with stable contact force, potentially enhancing safety and lesion quality. Previous studies demonstrated reduced radiation exposure and comparable efficacy to manual navigation, primarily in paroxysmal atrial fibrillation (pxAF). Evidence in persistent AF (perAF), particularly advanced stages, remains scarce. This study presents the first very long-term outcomes of RMN-guided ablation in perAF.
Methods: 383 patients were retrospectively analyzed (mean age 62.6 ± 9.1 years; 85.4% perAF, 14.6% pxAF) who underwent RMN-guided pulmonary vein isolation (PVI) with additional linear lesions as indicated (2009–2019). The cohort represented advanced atrial disease (85.4% persistent AF) with elevated CHA2DS2-VASc scores and frequent atrial tachyarrhythmias (AT); 96 repeat RMN procedures were additionally analyzed. Long-term success was defined as freedom from AF or AT recurrence beyond a 3-month blanking period. Survival and predictors were assessed using Kaplan–Meier and multivariable analyses.
Results: AF-free survival after the initial RMN procedure was 61.1%, 43.4%, 33.0%, 23.7%, and 18.0% at 12, 24, 36, 48, and 60 months, respectively. Freedom from any AT declined from 52.5% at 12 months to 11.5% at 60 months. Early recurrence during the blanking period strongly predicted long-term failure. Mean fluoroscopy and procedure times were 9.1 ± 10.1 minutes and 276 ± 84 minutes. Severe complications occurred in 5.0%.
Conclusion: Advanced persistent AF, RMN-guided ablation achieves modest long-term arrhythmia control with low complication rates. Early post-procedural AT recurrence is the strongest prognostic marker. RMN remains a feasible strategy for complex AF ablation and warrants further evaluation in high-risk populations.
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Copyright (c) 2026 Molatta S, et al.
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