title: Modified energy settings are mandatory to minimize oesophageal injury using the novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation.
abstract: OBJECTIVE
  The multipolar irrigated radiofrequency (RF) ablation catheter (nMARQ™) is a novel tool for pulmonary vein isolation (PVI). We investigated the incidence of thermal oesophageal injury (EI) using the nMARQ™ for PVI.
  
  
  RESULTS
  In the initial six patients (Group 1), RF was delivered at the posterior wall with a maximum duration of 60 s and a maximum power (maxP) of 20 W for unipolar ablation, and a maxP of 10 W for the bipolar ablation. In the latter 15 patients (Group 2), RF application was limited at the posterior wall to a maximum duration of 30 s and a maxP of 15 W for unipolar ablation a max P of 10 W for bipolar ablation. Oesophageal temperature monitoring was performed in all patients and ablation was terminated at a temperature rise >41°C. Endoscopy was carried out within 2 days post-ablation. Pulmonary vein isolation was performed during sinus rhythm and was successfully achieved in 83 of 84 PVs except the septal inferior vein in one patient. Charring was seen in 3 of 21 (14.3%) patients without any evidence of embolism. Phrenic nerve palsy occurred in one patient. Endoscopy revealed severe EI in 3 of 6 (50%) patients in Group 1 and in 1 of 15 patients (6.7%) in Group 2. Procedure times between Groups 1 and 2 were similar (228.3 ± 60.2 min vs. 221.3 ± 51.8 min; P = 0.79).
  
  
  CONCLUSIONS
  An unexpectedly high incidence of thermal EI was noted following PVI using the nMARQ™ with the initial ablation protocol. However, the incidence of thermal EI can be sigificantly reduced with limited power and RF application time at the posterior left atrium.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany arillig5@yahoo.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Gastroenterology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Burchard
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kamioka
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Heeger
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: Asklepios Proresearch, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, Hamburg, Germany.
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D002056:Burns / Q000453:epidemiology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D022062:Electrophysiologic Techniques, Cardiac; D004947:Esophagus / Q000293:injuries*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*
keywords: Atrial fibrillation; Catheter ablation; Multipolar irrigated radiofrequency ablation; Oesophageal lesion; Pulmonary vein isolation; Temperature monitoring; nMARQ™