27Is multipolar irrigated catheter better than conventional focal catheters in first-time atrial fibrillation ablation?

Introduction: nMARQ is a circular decapolar catheter designed for simultaneous mapping and regional multi-electrode ablation to achieve pulmonary vein isolation (PVI). We report short-term ablation outcome, procedural data and safety profile on nMARQ in first-time atrial fibrillation (AF) ablations compared to single-tip irrigated catheters. Method: From March 2013 to May 2014, we performed 236 first time AF ablations, 67 of which with nMARQ. Another 67 patients undergoing first AF ablations were selected as controls. For paroxysmal AF, we carried out left atrial circumferential ablation guided by CARTO-3 aimed at PVI. A stepwise approach was adopted with additional left atrial (LA) ablations for persistent AF or atypical atrial flutter as appropriate. For the nMARQ group, no other catheters were required to achieve the additional LA ablations. Results: Both nMARQ and non-nMARQ cohorts were matched in age, sex and ablation strategies. Procedure duration (152.5±6.7 vs. 236.8±9.6min; p<0.05) and ablation time (1656±241 vs. 4999±600s; p<0.05) were shorter in the nMARQ group irrespective of AF subtypes. Fluoroscopy time was higher in nMARQ (42.0±2.0 vs. 35.8±2.1min; p<0.05), reflecting a learning curve in familiarity with a new catheter. Six-month recurrence rate of atrial arrhythmias was comparable between nMARQ and non-nMARQ groups (2 in nMARQ vs. 7 in non-nMARQ; p=0.08) (Figure 1). There were no major complications. Conclusion: Early experience with nMARQ in AF ablation highlights its safety, timesaving advantage and non-inferiority to conventional catheters in short-term ablation outcome. Long-term safety and efficacy data is needed with longer follow up. ![Graphic][1] Figure 1 Kaplan-Meier plots of 6-month survival free from atrial arrhythmia following nMARQ or non-nMARQ AF ablations [1]: /embed/inline-graphic-1.gif