nMARQ Ablation for Atrial Fibrillation: Results from a Multicenter Study.
BACKGROUND
nMARQ is a multipolar catheter designed to simultaneously ablate at multiple sites around the pulmonary vein (PV) circumference with a single radiofrequency application. We sought to define the safety and efficacy of atrial fibrillation (AF) ablation with the nMARQ catheter.


METHODS
In a multicenter study, patients with drug-refractory AF were included. Procedural outcomes were documented at 1 year.


RESULTS
374 patients underwent PV isolation using nMARQ (age 60 ± 10 years, 264 male), of whom 263 patients had paroxysmal AF (PAF), while 111 patients had persistent AF. A total of 1,468 of 1,474 veins (99.6%) were isolated with the nMARQ catheter alone. Thirty-five (13%) PAF patients and 30 (27%) persistent AF patients underwent additional ablation at non-PV sites (2.4 ± 1.4 non-PV sites). Procedure time for PV isolation only was 1.9 ± 0.7 hours (fluoroscopy 24 ± 14 minutes). Procedure time for PV isolation and non-PV ablation was 2.4 ± 1.0 hours (fluoroscopy 30 ± 23 minutes). Major adverse events occurred in two patients (0.5%); one esophago-pericardial fistula and a second, mortality due to sepsis of unknown cause. One-year follow-up data were available in 65 (25%) PAF and 20 (18%) persistent AF patients. Forty-two (65%) PAF and 13 (65%) persistent AF patients were free of arrhythmia at 1 year. In patients undergoing repeat procedures (n = 17) the most frequent points of PV reconnection were: anterior RSPV, inferior RIPV, and superior LSPV.


CONCLUSIONS
AF ablation with nMARQ is associated with short procedure times and high acute success rates. Further research is necessary to more clearly define long-term outcome.
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Saagar
S
Mahida
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Darren A
DA
Hooks
Heart-Center Bad Neustadt, Clinic for Invasive Electrophysiology, Bad Neustadt, Germany.
Karin
K
Nentwich
NIHR Leicester Cardiovascular Biomedical Research Unit, Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, UK.
G Andre
GA
Ng
Francesco Miulli Hospital, Acquaviva delle Fonti, Bari, Italy.
Massimo
M
Grimaldi
Cardiac Arrhythmia Service, Divison of Cardiology, Pulmonology and Vascular Medicine, University Hospital, Duesseldorf, Germany.
Dong-In
DI
Shin
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Nicolas
N
Derval
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Frederic
F
Sacher
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Benjamin
B
Berte
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Seigo
S
Yamashita
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Arnaud
A
Denis
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Mélèze
M
Hocini
Heart-Center Bad Neustadt, Clinic for Invasive Electrophysiology, Bad Neustadt, Germany.
Thomas
T
Deneke
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Michel
M
Haissaguerre
Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, Bordeaux, Equipex MUSIC ANR-11-EQPX-0030, IHU LIRYC ANR-10-IAHU-04, Germany.
Pierre
P
Jais
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005060:Europe; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015641:Radiography, Interventional; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
atrial fibrillation; atrioesophageal fistula; catheter ablation; nMARQ catheter