Abstract
The success of catheter ablation depends not only on identification of arrhythmia mechanisms, mapping, and energy strategy, but also on catheter accessibility and stable manipulation. Robot-assisted catheter navigation enables remote control through magnetic fields, robotic sheaths, or mechanical actuation. However, with the development of three-dimensional electroanatomic mapping, low- and zero-fluoroscopy workflows, and newer ablation technologies, the key question has shifted from technical feasibility to whether these systems can overcome practical procedural constraints in specific clinical settings. This review synthesizes the clinical evidence for different robot-assisted catheter navigation technologies. Disease-specific comparative studies and long-term outcome data are derived mainly from robotic magnetic navigation. Current evidence consistently supports reduced conventional X-ray use with robotic navigation; in selected settings involving complex anatomy, abnormal vascular pathways, or limited catheter reachability, available studies show technical feasibility and procedural support, but consistent benefits in procedural efficiency, safety, and long-term patient outcomes have not been demonstrated. Its clinical value depends mainly on whether the dominant procedural limitation lies in catheter navigation and manipulation and is jointly influenced by the compatibility and availability of supporting technologies, the comparator, and center-specific workflow; procedural improvements do not necessarily translate into long-term patient benefit. Future studies should identify patients with a clear catheter-navigation need, distinguish the effect of robotic catheter navigation itself from that of the complete treatment strategy, and further evaluate its actual value for patients, operators, and healthcare systems.