Aim: The circular multi-electrode PVAC® catheter (Medtronic, Ablation Frontiers), a duty-cycled based technology, and the nMARQ™ catheter (Biosense Webster), an irrigated/ CARTO/ SMART TOUCH based technology, have recently been approved for AF ablation. We compared our experience with both technologies.
Methods and results: Pulmonary veins (PVs) anatomy was demonstrated by selective angiograms. Arrhythmogenic PVs were identified during ablation at sinus. We studied prospectively 110 consecutive patients who underwent AF ablation using PVAC® between 7/2011- 11/2013 (age 61 ± 10 y; 62% male, 22% persistent AF; 9% redo procedures) and 46 patients with nMARQ™ ablation between 5-11/2013 (age 63 ± 10 y; 67% male; 17% persistent AF; 15% redo – post PVAC® ablation). Procedure and radiation times were 107 ±45 and 37 ±20 minutes for PVAC® and 84 ±24 and 33 ± 12 for nMARQ™, (p=0.002 and 0.3), respectively. PV isolation was verified routinely in PVAC® but in only 3 nMARQ™ patients with very large PVs. Complications were: 1 tamponade (0.6%);4 pseudoaneurysm and 3 transient ST elevation in each group. No overt neurological sequel was observed. Triggers were apparent in 87% of PVAC® and 41% of nMARQ™ patients. 1&3 months freedom from AF (on drugs) were 63/86 (73%) and 65/77 (84%), respectively, for PVAC® versus 21/31 (68%) and 26/31 (84%) in nMARQ™. At one year, 32/43 (74%) and 41/43 (95%) of PVAC® patients were AF free after one and one or two procedures, respectively. In 2 nMARQ™ patients the small atria and PVs caused discontinuation of procedure and switching to PVAC®. In 2 failed PVAC® patients due to large PVs – a redo procedure with nMARQ™ was successful.
Conclusions: Both PVAC® and nMARQ™ have comparable relatively short procedure and radiation times, low complication rates and comparable success rates. Triggers are more common with PVAC®. nMARQ™ seems to be more suitable for larger atria and PVs, as opposed to PVAC®. A patient-based pre-ablation anatomy definition is probably warranted for appropriate selection of technology type.
