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Wakili, Reza; Siebermair, Johannes; Fichtner, Stephanie; Sinner, Moritz F.; Klocker, Eva; Olesch, Lucia; Hilberath, Jan N.; Sarai, Samira; Clauss, Sebastian; Sattler, Stefan; Kääb, Stefan; Estner, Heidi L. (2016): One-year clinical outcome after ablation with a novel multipolar irrigated ablation catheter for treatment of atrial fibrillation: potential implications for clinical use. In: Europace, Vol. 18, No. 8: pp. 1170-1178
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Abstract

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 (TM)) is aiming to improve PVI. We investigated the influence on procedural parameters and assessed clinical outcomes after PVI using this novel catheter. Fifty-eight consecutive patients with paroxysmal AF were equally allocated (n = 29/group) to PVI treatment with (i) the novel multipolar ablation catheter (nMARQ (TM)) 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 (TM). Pulmonary vein isolation was achieved in 100% in the SAC group. In the nMARQ (TM) group, PVI was suggested in all patients. However, confirmatory mapping revealed persistent pulmonary vein (PV) conduction in 19 out of 29 nMARQ (TM) patients. These patients underwent further ablation, which still failed to achieve PVI in 5 of the 29 nMARQ (TM) 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 (TM) vs. SAC patients. Radiofrequency time was shorter in nMARQ (TM) 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 (TM): 72 vs. SAC: 72%) after a mean follow-up of 373 +/- 278 days. The use of the nMARQ (TM) catheter is associated with important device-related limitations to achieve successful PVI. However, clinical outcomes were equivalent in nMARQ (TM)- and SAC-treated patients.