Does the use of a circular ablation catheter (nMARQ) improve acute and long-term success rates of pulmonary vein isolation compared to point-by-point contact-force ablation (Smart Touch) in patients with atrial fibrillation?
Both circular and point-by-point contact-force ablation catheters achieve similar long-term success rates for pulmonary vein isolation in atrial fibrillation, though circular ablation may reduce procedural time in paroxysmal cases.
INTRODUCTION: Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is now standard care for atrial fibrillation (AF). New improvements in PVI techniques include use of catheters that measure contact-force and circular ablation catheters. These techniques have not been compared. METHODS AND RESULTS: We compared the success rate of circumferential pulmonary vein isolation (CPVI) with: (1) "point by point" RF using an irrigated tip ablation catheter with "smart touch" contact-force; (2) irrigated nMARQ circular ablation catheter in 86 patients with AF. The endpoints of the study were acute and long-term success rate of CPVI. The 2 groups had similar characteristics: Smart Touch group with 50 patients, age 62 ± 8 years, 64% male; nMARQ group with 36 patients, 75% male, age 58.7 ± 10 years. The type of AF was similar in the 2 groups: paroxysmal and persistent in 68% and 32% in the Navistar group versus 64% and 36% in the nMARQ group. Follow-up periods were similar (18.4 months vs. 19 months, P = 0.59). All the pulmonary veins were successfully isolated in both groups. However, PVI could not be achieved with the nMARQ in 2.7% of the pulmonary veins ablated and was completed with a Smart Touch. The long-term success rate was comparable in the 2 groups. CONCLUSION: The nMARQ and Smart Touch catheters give similar results in PVI of both paroxysmal and persistent AF. The procedural time was shorter with the nMARQ in paroxysmal AF. Need for crossover from nMARQ to Smart Touch occurred in 2.7% of PVs ablated.
Rosso et al. (Tue,) studied this question.