title: Safety, efficacy, and clinical applicability of pulmonary vein isolation with circular multi-electrode ablation systems: PVAC® vs. nMARQ™ for atrial fibrillation ablation.
abstract: OBJECTIVE
  We compare our experience with available circular multi-electrode catheters for atrial fibrillation (AF) ablation: PVAC(®), a phased radiofrequency system, and nMARQ™, an irrigated tip-CARTO-based technology.
  
  
  RESULTS
  Prospective observational study of 175 consecutive patients with follow-up duration of at least 5 months who underwent pulmonary vein isolation (PVI) for symptomatic AF using PVAC(®) (n = 93, age 61.4 ± 9.8 years; 60% male, 13% persistent AF) vs. nMARQ™ (n = 82, age 63.2 ± 10.6 years; 67% male, 24% persistent AF). Procedure and radiation times were 94 ± 27 and 33 ± 13 min for PVAC(®) and 81 ± 18 and 30 ± 8.5 for nMARQ™ (P = 0.0008 and P = 0.18), respectively. The number of applications and the total burning time (min) were 20 ± 7 and 19 ± 6.7 for PVAC(®) and 16 ± 5.6 and 11 ± 4 for nMARQ™ (P < 0.0001 for both), respectively. In two nMARQ™ patients with small atria and pulmonary veins (PVs) and in two PVAC(®) patients with large PVs, the procedure failed; switching to the alternative technology was successful. Acute success rate was 97% for PVAC(®) and 95% for nMARQ™. There was one tamponade in nMARQ™ group and non-significant different minor complications for both techniques. One-year freedom from AF was 79 and 80.7% with PVAC(®) vs. nMARQ™, after one PVI, and 88 vs. 87.7% after two PVIs.
  
  
  CONCLUSIONS
  Both technologies have short procedure and fluoroscopy times, comparable complication rates, and comparable acute and 1-year success rates. The number of applications and total procedure and burning times were shorter with nMARQ™. nMARQ™ was more suitable for larger atria and PVs. Thus, a patient-based pre-ablation anatomy definition is probably warranted for appropriate selection of technology type.
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel avishagl@inter.net.il.
authors.forename: Avishag
authors.initials: A
authors.lastname: Laish-Farkash
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khalameizer
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Fishman
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Ornit
authors.initials: O
authors.lastname: Cohen
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Chaim
authors.initials: C
authors.lastname: Yosefy
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Cohen
authors.affiliation: Electrophysiology Unit, Department of Cardiology, Barzilai Medical Center, Barzilai MC, 2 Hahistadrout Street, Ashkelon 78278, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Katz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; PVAC; Pulmonary vein isolation; nMARQ