Direct results of a prospective randomized study comparing ablation with the nMARQ catheter and the PVAC catheter used with and without a 3D system (MAPER 3D Study)

Introduction: Our aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control. Material and methods: One hundred two patients (70 male, 57 11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 -ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 -a PVAC catheter used with the EnSite system; group 3 -ablation with a PVAC catheter without a 3D system. Results: Complete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 2.9 min/808.8 393.9 cGy/cm 2 vs. 13.6 5.6 min/1662.6 677.8 cGy/ cm 2 and 18.8 7.6 min/2327.9 975.5 cGy/cm 2 ; p < 0.001). Procedure duration was shorter in group 1 (82.9 18.8 min vs. 101.2 19.6 min, p < 0.001 and 99.8 20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 543.5 ml vs. 1077.9 280.5 ml and 1076.5 375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up. Conclusions: The lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid.