title: Ablation of atrial fibrillation and esophageal injury: Role of bipolar and unipolar energy using a novel multipolar irrigated ablation catheter.
abstract: BACKGROUND
  The circular nMARQ ablation catheter is a useful tool for pulmonary vein isolation (PVI). Some studies reported a high incidence of esophageal lesions by using this catheter.
  
  
  OBJECTIVE
  The primary aim of this study was to compare the effects on the esophageal wall of bipolar and unipolar energy applied by the nMARQ ablation catheter during AF ablation.
  
  
  METHODS
  Forty patients (mean age 53 ± 8 years; 26 [65%] men) were enrolled to perform PVI for symptomatic atrial fibrillation. Thirty patients underwent PVI with the nMARQ catheter (group 1) and 10 patients with the ThermoCool Surround Flow catheter (group 2). The procedures were performed with the CARTO3 system. All patients received an esophageal temperature probe. In group 1, we delivered unipolar energy on the left posterior wall with power between 15 and 18 W or bipolar energy with power at 15 W. In group 2, unipolar energy was delivered on the posterior atrial wall at 20-25 W power. All patients underwent esophagoscopy the day after the procedure.
  
  
  RESULTS
  No patients had procedural complications. In group 1, bipolar energy was associated with a lower esophageal temperature increase as compared with unipolar energy (0.6°C [range 0-2.2°C] vs 2.1°C [range 0.8-2.9°C]; P < .001). Unipolar energy was associated with a similar temperature increase in the 2 groups (1.9°C [range 0.8-2.9°C] in group 1 vs 1.7°C [range 0.7-2.9°C] in group 2; P = .49). No patient had esophageal injury.
  
  
  CONCLUSIONS
  The use of the nMARQ catheter for PVI is feasible and safe. The use of 15 W for bipolar energy or 15-18 W for unipolar energy is an optimal strategy to avoid esophageal injury with this new catheter.
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Monaco
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Quadrini
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Katsouras
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Caccavo
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Troisi
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Gastroenterologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Quatraro
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cecere
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Langialonga
authors.affiliation: Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy. Electronic address: fiatric@hotmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Grimaldi
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery; D001831:Body Temperature; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation*; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011667:Pulmonary Veins
keywords: Atrial fibrillation; Bipolar and unipolar energy; Esophageal injury; Pulmonary vein isolation; nMARQ ablation catheter