Applications of robotic catheter ablation in congenital heart disease

Robotic catheter ablation has evolved from a niche technology into a practical platform for treating arrhythmias in patients with congenital heart disease, a population in whom altered vascular routes, surgically created baffles and conduits, chamber enlargement, and prosthetic material frequently render catheter access and stability dominant procedural challenges. Robotic magnetic navigation, the principal robotic system used in congenital heart disease, combines a highly flexible magnet-tipped catheter with externally controlled magnetic fields to enable precise catheter orientation and stable contact in the context of challenging vascular access and complex anatomies. Although the evidence base for robotic ablation in congenital heart disease remains largely observational, contemporary pooled analyses, case series, and focused reports consistently support its feasibility, safety, and high acute effectiveness. Beyond procedural success, these data suggest meaningful advantages in selected domains, including reduced radiation exposure and less operator fatigue during prolonged, high-complexity cases. Importantly, robotic navigation may also serve as an enabling technology in anatomies that are otherwise difficult to access or associated with increased procedural risk using conventional manual approaches. This perspective synthesizes the current literature, proposes practical criteria for selecting cases with congenital heart disease in which robotic ablation should be considered early, and outlines a forward-looking research and implementation agenda emphasizing anatomy-driven indications, and standardized workflows.