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Europace. 2016 Jun;18(6):807-14. doi: 10.1093/europace/euv258. Epub 2015 Nov 20.

Safety, efficacy, and clinical applicability of pulmonary vein isolation with circular multi-electrode ablation systems: PVAC® vs. nMARQ™ for atrial fibrillation ablation.

Author information

1
Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel avishagl@inter.net.il.
2
Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Abstract

AIMS:

We compare our experience with available circular multi-electrode catheters for atrial fibrillation (AF) ablation: PVAC(®), a phased radiofrequency system, and nMARQ™, an irrigated tip-CARTO-based technology.

METHODS AND RESULTS:

Prospective observational study of 175 consecutive patients with follow-up duration of at least 5 months who underwent pulmonary vein isolation (PVI) for symptomatic AF using PVAC(®) (n = 93, age 61.4 ± 9.8 years; 60% male, 13% persistent AF) vs. nMARQ™ (n = 82, age 63.2 ± 10.6 years; 67% male, 24% persistent AF). Procedure and radiation times were 94 ± 27 and 33 ± 13 min for PVAC(®) and 81 ± 18 and 30 ± 8.5 for nMARQ™ (P = 0.0008 and P = 0.18), respectively. The number of applications and the total burning time (min) were 20 ± 7 and 19 ± 6.7 for PVAC(®) and 16 ± 5.6 and 11 ± 4 for nMARQ™ (P < 0.0001 for both), respectively. In two nMARQ™ patients with small atria and pulmonary veins (PVs) and in two PVAC(®) patients with large PVs, the procedure failed; switching to the alternative technology was successful. Acute success rate was 97% for PVAC(®) and 95% for nMARQ™. There was one tamponade in nMARQ™ group and non-significant different minor complications for both techniques. One-year freedom from AF was 79 and 80.7% with PVAC(®) vs. nMARQ™, after one PVI, and 88 vs. 87.7% after two PVIs.

CONCLUSION:

Both technologies have short procedure and fluoroscopy times, comparable complication rates, and comparable acute and 1-year success rates. The number of applications and total procedure and burning times were shorter with nMARQ™. nMARQ™ was more suitable for larger atria and PVs. Thus, a patient-based pre-ablation anatomy definition is probably warranted for appropriate selection of technology type.

KEYWORDS:

Atrial fibrillation; Catheter ablation; PVAC; Pulmonary vein isolation; nMARQ

PMID:
26589623
DOI:
10.1093/europace/euv258
[Indexed for MEDLINE]

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