First in vivo robotic-assisted pulsed field ablation for atrial fibrillation in a swine model: a case report

Background: Robotic-assisted procedures are rapidly advancing in interventional cardiology and have shown advantages in performing atrial fibrillation ablation. However, their application in combination with pulsed field ablation (PFA) remains unexplored. Case summary: experience of robotic-assisted PFA. The robotic-assisted PFA system comprises of a robotic articulating arm with three sterile, single-use functional modules, a workstation console, and a control computer. Following transseptal puncture and electrical mapping, two experienced operators performed pulmonary vein isolation and superior vena cava isolation in a swine model using the robotic system integrated with a guiding sheath and a PFA catheter. The procedure was conducted under fluoroscopy, while operators controlled the system remotely via the console in a zero-radiation environment. Post-procedural voltage mapping and histological analysis confirmed the feasibility of robotic-assisted PFA. Discussion: The primary advantage of robotic-assisted PFA is the potential to enable remote operation. It may also improve catheter stability and reduce the learning curve for performing PFA. Potential risks of robotic-assisted PFA include violent damage to cardiac tissue and complications associated with PFA. The robotic-assisted PFA system is sensitive and accurate when operated on a swine model, though several challenges exist in translating findings from a swine model to human clinical practice, and further studies are needed to evaluate its safety and efficacy before clinical implementation.