Ablation using the novel multipolar nMARQ catheter resulted in equivalent freedom from atrial fibrillation compared to a standard single-tip catheter (72% vs 72%) after a mean follow-up of 373 days.
RCT (n=58)
Does pulmonary vein isolation with a novel multipolar irrigated ablation catheter improve freedom from atrial fibrillation and procedural parameters compared to a standard single-tip catheter in patients with paroxysmal atrial fibrillation?
The novel multipolar irrigated ablation catheter nMARQ™ yielded similar 1-year freedom from atrial fibrillation compared to standard single-tip catheters but was associated with device-related limitations in achieving successful pulmonary vein isolation.
Absolute Event Rate: 72% vs 72%
AIMS: Pulmonary vein isolation (PVI) is an established therapy for atrial fibrillation (AF). However, PVI remains a time-consuming procedure. A novel multipolar irrigated radiofrequency (RF) ablation catheter (nMARQ™) is aiming to improve PVI. We investigated the influence on procedural parameters and assessed clinical outcomes after PVI using this novel catheter. METHODS AND RESULTS: Fifty-eight consecutive patients with paroxysmal AF were equally allocated (n = 29/group) to PVI treatment with (i) the novel multipolar ablation catheter (nMARQ™) and (ii) a standard single-tip ablation catheter (SAC). Study endpoints included procedure time, fluoroscopy time, radiation dose, RF time, number of energy applications, and clinical outcome defined as freedom from AF after a single procedure. Successful PVI was confirmed by a separate circular, multipolar mapping catheter in all patients treated with the nMARQ™. Pulmonary vein isolation was achieved in 100% in the SAC group. In the nMARQ™ group, PVI was suggested in all patients. However, confirmatory mapping revealed persistent pulmonary vein (PV) conduction in 19 out of 29 nMARQ™ patients. These patients underwent further ablation, which still failed to achieve PVI in 5 of the 29 nMARQ™ patients, mainly due to significant temperature rise in the oesophagus and device-related limitations reaching the right inferior PV. Mean fluoroscopy time (31 ± 12 vs. 23 ± 10 min, P < 0.05) and (132 ± 37 vs. 109 ± 30 min, P < 0.05) were longer in nMARQ™ vs. SAC patients. Radiofrequency time was shorter in nMARQ™ vs. SAC group (21 ± 9 vs. 35 ± 12 min, P < 0.001). Radiation dose and the number of energy applications did not differ between both groups. Clinical outcome analysis revealed no significant differences (nMARQ™: 72 vs. SAC: 72%) after a mean follow-up of 373 ± 278 days. CONCLUSION: The use of the nMARQ™ catheter is associated with important device-related limitations to achieve successful PVI. However, clinical outcomes were equivalent in nMARQ™- and SAC-treated patients.
Wakili et al. (Mon,) conducted a rct in Paroxysmal atrial fibrillation (n=58). nMARQ multipolar irrigated radiofrequency ablation catheter vs. Standard single-tip ablation catheter (SAC) was evaluated on Freedom from AF after a single procedure. Ablation using the novel multipolar nMARQ catheter resulted in equivalent freedom from atrial fibrillation compared to a standard single-tip catheter (72% vs 72%) after a mean follow-up of 373 days.