Background: The nMARQ™ multi-electrode catheter has become an acceptable method for pulmonary vein isolation (PVI). The probable advantages of using nMARQ™ for mapping and ablating atypical atrial flutter (AAFL) in the setting of atrial fibrillation (AF) ablation are: the high quality of signals; the speed of mapping; the safety of the catheter; and the immediate ablation right at the most appropriate area of mapping without the delay of manipulating an additional catheter.
Aim: To assess the feasibility and safety of ablating both AF and AAFL during the same procedure using nMARQ™ catheter alone.
Methods: Seven patients (43% male, 61±15y, 71% redo) with symptomatic paroxysmal AF and intermittent AAFL underwent PVI using nMARQ™ catheter. We then induced a sustained AAFL. It was mapped with CARTO 3 system using the nMARQ™ catheter alone, which was already inside the left atrium (LA). We used ten electrodes simultaneously, and applied de-Ponti method for creating the window of interest. Only clear signals with satisfactory contact were included (contact tissue indication of nMARQ™).
Results: In all cases but one, a reentry mechanism was shown at the ostium of the veins: RSPV (n=4)/ RIPV (2)/ LIPV (2)/ LSPV (1) or in LA roof (n=2), where “head meets tail” was demonstrated in the LAT map. In four patients more than one AAFL with different cycle lengths were demonstrated. We used few electrodes only for creating a line of ablation to disconnect these loops. This line had terminated the flutter during ablation and no further arrhythmia could be induced in six patients (86%). No complications were noted in all patients.
Conclusion: AAFL 3D mapping using nMARQ™ catheter alone in the setting of PVI is feasible, fast, safe and may spare the usage of an additional ablation catheter. The role of using nMARQ™ a priori- in left AFL cases with no AF on board- needs to be further validated.
