Background: Catheter ablation is an interventional technique used in the treatment of arrhythmias, including atrial fibrillation (AF), a condition where there is disordered electrical activity and ineffectual atrial contraction, leading to a supraventricular tachyarrhythmia. Robotic catheter systems (RCS) are a valid option for use within clinical practice due to their potential capacity to reduce complication rate, improve fluoroscopy times and improve success rates when compared with manual procedures.

Objective: To determine if RCS are a viable or better alternative to manual catheter ablation therapy for use within clinical practice for patients suffering from AF. 

Methods: We conducted a systematic review into the literature on this topic up to the 10th December 2021. EMBASE, MEDLINE, Cochrane Library CENTRAL and SCOPUS were the databases searched to identify relevant studies to this topic. Keywords searched included “robotic”, “catheter” or “ablation” annexed with “atrial fibrillation”, “arrhythmia” or “supraventricular”. Grey literature and smaller journals were not assessed, nor were journals that had no English language full-text, abstract or title available. Figure 4 illustrates our inclusion and exclusion criteria.

Results: A total of 14 studies were found that included 5052 patients in total. Studies were of varying quality; however, all studies included a comparison between RCS and manual ablation. Most of the studies analysed found a statistically significant improvement in one of our outcome measures when comparing RCS to manual ablation. The outcome measures assessed included fluoroscopy time, success rates, complication rates, contact force, procedure time and radiation dose.

Conclusions: RCS are a viable alternative to manual ablation when treating AF due to reduced fluoroscopy times, increased or equal success rates and noninferiority with complication rates when compared to manual ablation. There were some studies that showed improvements in RCS when assessing radiation dose and catheter contact force. Procedural times were increased in RCS when compared to manual ablation. These findings are promising for the future integration of RCS into clinical practice.