The comparison between robotic and manual ablations in the treatment of atrial fibrillation: a systematic review and meta-analysis

Wenli Zhang, Nan Jia, Jinzi Su, Jinxiu Lin, Feng Peng, Wenquan Niu, Wenli Zhang, Nan Jia, Jinzi Su, Jinxiu Lin, Feng Peng, Wenquan Niu

Abstract

Objective: To examine in what aspects and to what extent robotic ablation is superior over manual ablation, we sought to design a meta-analysis to compare clinical outcomes between the two ablations in the treatment of atrial fibrillation.

Methods and results: A literature search was conducted of PubMed and EMBASE databases before December 1, 2013. Data were extracted independently and in duplicate from 8 clinical articles and 792 patients. Effect estimates were expressed as weighted mean difference (WMD) or odds ratio (OR) and the accompanied 95% confidence interval (95% CI). Pooling the results of all qualified trials found significant reductions in fluoroscopic time (minutes) (WMD; 95% CI; P: -8.9; -12.54 to -5.26; <0.0005) and dose-area product (Gy×cm2) (WMD; 95% CI; P: -1065.66; -1714.36 to -416.96; 0.001) for robotic ablation relative to manual ablation, with evident heterogeneity (P<0.0005) and a low probability of publication bias. In subgroup analysis, great improvement of fluoroscopic time in patients with robotic ablation was consistently presented in both randomized and nonrandomized clinical trials, particularly in the former (WMD; 95% CI; P: -12.61; -15.13 to -10.09; <0.0005). Success rate of catheter ablation was relatively higher in patients with robotic ablation than with manual ablation (OR; 95% CI; P: 3.45; 0.24 to 49.0; 0.36), the difference yet exhibiting no statistical significance.

Conclusions: This study confirmed and extended previous observations by quantifying great reductions of fluoroscopic time and dose-area product in patients referred for robotic ablation than for manual ablation in the treatment of atrial fibrillation, especially in randomized clinical trials.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of search strategy…
Figure 1. Flow diagram of search strategy and study selection.
Figure 2. Forest plots of changes of…
Figure 2. Forest plots of changes of fluoroscopic time, total procedure time, radiofrequency time, dose-area product for the comparison of robotic ablation with manual ablation.
Figure 3. Filled funnel plots of fluoroscopic…
Figure 3. Filled funnel plots of fluoroscopic time, total procedure time, radiofrequency time, dose-area product for the comparison of robotic ablation with manual ablation.
Figure 4. Forest plots of changes of…
Figure 4. Forest plots of changes of the successful procedure of catheter ablation and the incidence of major complications for the comparison of robotic ablation with manual ablation.

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Source: PubMed

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