Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in both paroxysmal and persistent AF. However, this procedure is still challenging and time consuming. Objective: The aim of this study was to present our approach for PVI using a novel circular irrigated multielectrode mapping and ablation catheter (nMARQTM) and to present acute and mid-term results. Methods: The study included 31 consecutive patients with symptomatic AF (4 had persistent and 27 had paroxysmal AF) who underwent PVI using the nMARQTM catheter. Circular ablation was guided by CT image integrated into fast anatomical map and by intra cardiac echo. Isolation of pulmonary veins was identified using the nMARQTM catheter if it was possible to advance it into the veins, otherwise Lasso catheter was used. Patients were followed up to 20 months. Results: PVI was achieved in 119 (98%) out of 121 pulmonary veins identified, and final PVI was obtained in 30 (97%) out of 31 patients. Lasso catheter was needed for PVI confirmation in 16 (52%) patients. Touch up ablation using standard catheter guided by Lasso catheter was needed in 4 (13%) patients. Pericardial tamponade occurred in 1 patient who was treated with pericardiocentesis. No other major complications were detected. During follow-up (mean 15.9 ± 3.6 months, range 9 - 20 months), 4 (13%) patients had recurrence of atrial tachyarrhythmia. Conclusion: PVI using the novel nMARQTM catheter is safe with good acute and mid-term efficacy. Long term follow up trials are needed.
References
[1]
Calkins, H., Kuck, K.H, Cappato, R., Brugada, J., Camm, A.J., Chen, S.A., et al. ( 2012) 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-Up, Definitions, Endpoints, and Research Trial Design: A Report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Heart Rhythm, 9, 632-696. https://doi.org/10.1016/j.hrthm.2011.12.016
[2]
Roten, L., Derval, N., Pascale, P., Scherr, D., Komatsu, Y., Shah, A., et al. (2012) Current Hot Potatoes in Atrial Fibrillation Ablation. Current Cardiology Reviews, 8, 327-346. https://doi.org/10.2174/157340312803760802
[3]
Schmidt, M., Dorwarth, U., Andresen, D., Brachmann, J., Kuck, K.H., Kuniss, M., et al. (2014) Cryoballoon versus RF Ablation in Paroxysmal Atrial Fibrillation: Results from the German Ablation Registry. Journal of Cardiovascular Electrophysiology, 25, 1-7. https://doi.org/10.1111/jce.12267
[4]
Deneke, T., de Groot, J.R., Horlitz, M., Mügge, A., Grewe, P.H., et al. (2009) Pulmonary Vein Isolation Using a Novel Decapolar over-the-Wire Mapping and Ablation Catheter. Expert Review of Cardiovascular Therapy, 7, 1341-1347. https://doi.org/10.1586/erc.09.116
[5]
Shin, D.I., Kirmanoglou, K., Eickholt, C., Schmidt, J., Clasen, L., Butzbach, B., et al. (2014) Initial Results of Using a Novel Irrigated Multielectrode Mapping and Ablation Catheter for Pulmonary Vein Isolation. Heart Rhythm, 11, 375-383. https://doi.org/10.1016/j.hrthm.2013.12.008
[6]
Kistler, P.M., Earley, M.J., Harris, S., Abrams, D., Ellis, S., Sporton, S.C., et al. (2006) Validation of Three-Dimensional Cardiac Image Integration: Use of Integrated CT Image into Electroanatomic Mapping System to Perform Catheter Ablation of Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 17, 341-348. https://doi.org/10.1111/j.1540-8167.2006.00371.x
[7]
Scaglione, M., Caponi, D., Anselmino, M., Di Clemente, F., Blandino, A., Ferraris, F., et al. (2014) Pulmonary Vein Isolation with a New Multipolar Irrigated Radiofrequency Ablation Catheter (nMARQ™): Feasibility, Acute and Short-Term Efficacy, Safety, and Impact on Postablation Silent Cerebral Ischemia. Journal of Cardiovascular Electrophysiology, 25, 1299-1305. https://doi.org/10.1111/jce.12500
[8]
Deneke, T., Schade, A., Müller, P., Schmitt, R., Christopoulos, G., Krug, J., et al. (2014) Acute Safety and Efficacy of a Novel Multipolar Irrigated Radiofrequency Ablation Catheter for Pulmonary Vein Isolation. Journal of Cardiovascular Electrophysiology, 25, 339-345. https://doi.org/10.1111/jce.12316
[9]
Ouyang, F., Bänsch, D., Ernst, S., Schaumann, A., Hachiya, H., Chen, M., et al. (2004) Complete Isolation of Left Atrium Surrounding the Pulmonary Veins: New Insights from the Double-Lasso Technique in Paroxysmal Atrial Fibrillation. Circulation, 110, 2090-2096. https://doi.org/10.1161/01.CIR.0000144459.37455.EE
[10]
Dukkipati, S.R., Kuck, K.H., Neuzil, P., Woollett, I., Kautzner, J., McElderry, H.T., et al. (2013) Pulmonary Vein Isolation Using a Visually Guided Laser Balloon Catheter: The First 200-Patient Multicenter Clinical Experience. Circulation: Arrhythmia and Electrophysiology, 6, 467-472. https://doi.org/10.1161/CIRCEP.113.000431
[11]
Rosso, R., Halkin, A., Michowitz, Y., Belhassen, B., Glick, A. and Viskin, S. (2014) Radiofrequency Ablation of Paroxysmal Atrial Fibrillation with the New Irrigated Multipolar nMARQ Ablation Catheter: Verification of Intracardiac Signals with a Second Circular Mapping Catheter. Heart Rhythm, 11, 559-565. https://doi.org/10.1016/j.hrthm.2013.12.029
[12]
Deneke, T., Schade, A., Diegeler, A. and Nentwich, K. (2014) Esophago-Pericardial Fistula Complicating Atrial Fibrillation Ablation Using a Novel Irrigated Radiofrequency Multipolar Ablation Catheter. Journal of Cardiovascular Electrophysiology, 25, 442-443. https://doi.org/10.1111/jce.12308
[13]
Kenigsberg, D.N., Lee, B.P., Grizzard, J.D., Ellenbogen, K.A. and Wood, M.A. (2007) Accuracy of Intracardiac Echocardiography for Assessing the Esophageal Course along the Posterior Left Atrium: A Comparison to Magnetic Resonance Imaging. Journal of Cardiovascular Electrophysiology, 18, 169-173. https://doi.org/10.1111/j.1540-8167.2006.00699.x
[14]
Piccini, J.P., Lopes, R.D., Kong, M.H., Hasselblad, V., Jackson, K. and Al-Khatib, S.M. (2009) Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients with Atrial Fibrillation: A Meta-Analysis of Randomized, Controlled Trials. Circulation: Arrhythmia and Electrophysiology, 2, 626-633. https://doi.org/10.1161/CIRCEP.109.856633
[15]
Ouyang, F., Tilz, R., Chun, J., Schmidt, B., Wissner, E., Zerm, T., et al. (2010) Long-Term Results of Catheter Ablation in Paroxysmal Atrial Fibrillation: Lessons from a 5-Year Follow-Up. Circulation, 122, 2368-2377. https://doi.org/10.1161/CIRCULATIONAHA.110.946806
[16]
Zellerhoff, S., Daly, M., Lim, H.S., Denis, A., Komatsu, Y., Jesel, L., et al. (2014) Pulmonary Vein Isolation Using a Circular, Open Irrigated Mapping and Ablation Catheter (nMARQ): A Report on Feasibility and Efficacy. Europace, 16, 1296-1303. https://doi.org/10.1093/europace/euu133
[17]
Mahida, S., Hooks, D.A., Nentwich, K., Ng, G.A., Grimaldi, M., Shin, D.I., et al. (2015) nMARQ Ablation for Atrial Fibrillation: Results from a Multicenter Study. Journal of Cardiovascular Electrophysiology, 26, 724-729.
https://doi.org/10.1111/jce.12698
[18]
Stabile, G., de Ruvo, E., Grimaldi, M., Rovaris, G., Soldati, E., Anselmino, M., et al. (2015) Safety and Efficacy of Pulmonary Vein Isolation Using a Circular, Open-Irrigated Mapping and Ablation Catheter: A Multicenter Registry. Heart Rhythm, 12, 1782-1788. https://doi.org/10.1016/j.hrthm.2015.05.025
