Cardiac Magnetic Resonance-Guided Robotic Ablation of Atrial Fibrillation

Background: Robotic-assisted ablation of atrial fibrillation (RA-AF) is a minimally invasive procedure that requires accurate planning and anatomical assessment to reduce the risk of complications: Cardiac Magnetic Resonance (CMR) can safely be used for pre-procedural planning, providing good quality images without the use of ionizing radiation. The aim of the study is to evaluate how CMR can be used to assist the surgeon in the planning and execution of a safe and effective robotic-assisted procedure. Methods: A single-center observational study of 27 patients (25 persistent AF, 2 paroxysmal AF) undergoing robotic-assisted left atrial epicardial ablation with left atrial appendage exclusion. CMR was used in 22 patients; 5 underwent CT due to contraindications. Three-dimensional CMR reconstructions were reviewed preoperatively to optimize probe placement and energy delivery. The contrast agent used was gadoteridol (ProHance®, Bracco Imaging, Milan, Italy; catalog no. 117258). Results: Mean age was 64 ± 7 years; 81% were male. Hypertension (81%) and diabetes (22%) were common comorbidities. CMR showed enlarged LA (volume index 76 ± 17.6 mL/m2) and fibrosis predominantly on the LA roof (81%) and lateral wall (45%). No LAA thrombi were observed. All patients underwent successful robotic AF ablation with no intraoperative ischemic or bleeding complications. 3D CMR reconstructions facilitated intraoperative surgical guidance. Conclusions: CMR-guided robotic AF ablation is feasible, safe, and effective. Pre-procedural fibrosis mapping and 3D anatomical visualization enhance surgical planning and may improve outcomes. Larger prospective studies are required to confirm prognostic value.