Background: Pulmonary vein isolation (PVI) using the novel irrigated multi-electrode ablation system (nMARQ™) remains challenging in complex atrial anatomy cases despite electro-anatomical mapping (EAM) due to absence of a leading guide-wire.
Objective: To assess initial experience of PVI using nMARQ™ catheter with intra-procedural contrast injections through the deflectable sheath compared to nMARQ™ alone.
Methods: Sixty consecutive patients with atrial fibrillation (AF) underwent PVI using nMARQ™ catheter. The first group (n=37, 64±10.5 years, 62% male, 13.5% persistent AF) underwent the procedure with the guidance of signal mapping, fluoroscopy, and EAM alone; in the second group (n=23, 65±10.5 years, 65% male, 39% persistent AF), an automatic closed-loop contrast media injector was added to improve catheter localization at the antral region of pulmonary veins (PVs).
Results: The total procedure time was 78±19 minutes and 87±19 for the first and second groups, respectively (NS); mean fluoroscopy time was 30±9 minutes and 32±9, respectively (NS); acute success rate was 97% and 96%, with a mean of 14±6 and 18±6 RF applications, respectively (p=.03); and mean total burning time of 10±4 and 12±5 minutes, respectively (p=.08). Mean contrast used was 55±13 mL versus 206±68 mL, respectively, with no effect on renal function or major complications in both groups.
Conclusions: Addition of contrast injections to standard nMARQ™ procedure is feasible and safe. Although it does not prolong the procedure significantly, it requires more applications. This tool may have an added value to EAM in catheter localization by newly trained operators and in selective cases of large/common PV anatomy.
