Utilization of Steerable Sheath Improves the Efficacy of Atrial Fibrillation Ablation Guided by Remote Magnetic Navigation Compared with Fixed-curve Sheath

Background: The objective of this study was to assess the impact of steerable sheath on the procedural outcomes of atrial fibrillation (AF) ablation compared with fixed-curve sheath guided by remote magnetic navigation (RMN). Methods and results In this study, 110 patients scheduled for AF catheter ablation were enrolled and divided into two groups. 55 patients (paroxysmal, 70%) were performed with steerable sheath and another 55 patients (paroxysmal, 70%) were completed with fixed-curve sheath. Clinical characteristics were similar between the two groups. Compared with fixed-curve sheath group, the procedure time (111.9±25.2 vs. 90.4±20.7 mins, P＜0.001) and radiofrequency (RF) time (35.9±9.0 vs. 30.5±7.4 mins, P＜0.001) were significantly shortened, additionally, the navigation index value was improved greatly (0.41 ± 0.06 vs. 0.48 ± 0.08, P＜0.001) in the steerable sheath group. By means of a big loop for targeting the right pulmonary vein (PV), the steerable sheath group significantly reduced the RF delivery time (15.0±3.0 vs. 12.0±2.1 mins, P＜0.001) during the right-side PV isolation (PVI). However, total fluoroscopy time was similar between the two groups (5.6±2.6 vs. 4.97±2.0 mins, P＞0.05). Acute PVI success rate were similar between the two groups. No major or minor complications occurred in all the patients. Conclusion Appropriate utilization of steerable sheath technology can improve the efficacy of AF ablation guided by RMN, majorly by reducing the procedure and RF delivery time of right-side PVI without compromising safety.