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

Abstract

Aims We compare our experience with available circular multi-electrode catheters for atrial fibrillation (AF) ablation: PVACw, a phased radiofrequency system, and nMARQTM, 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 PVACw (n = 93, age 61.4±9.8 years; 60% male, 13% persistent AF) vs. nMARQTM (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 PVACw and 81±18 and 30±8.5 for nMARQTM (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 PVACw and 16±5.6 and 11±4 for nMARQTM (P, 0.0001 for both), respectively. In two nMARQTM patients with small atria and pulmonary veins (PVs) and in two PVACw patients with large PVs, the procedure failed; switching to the alternative technology was successful. Acute success rate was 97% for PVACw and 95% for nMARQTM. There was one tamponade in nMARQTM group and non-significant different minor complications for both techniques. One-year freedom from AF was 79 and 80.7% with PVACw vs. nMARQTM, 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 nMARQTM. nMARQTM 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. Published on behalf of the European Society of Cardiology. All rights reserved.