Usefulness of intracardiac echocardiography during pulmonary vein isolation with the novel multipolar irrigated ablation catheter (nMARQ(TM)

Background: Previous studies reported the usefulness of an irrigated circular radiofrequency ablation catheter (nMARQTM, Biosense Webster) for pulmonary vein isolation (PVI). We evaluated the role of intracardiac echocardiography (ICE) to optimize the manipulation of nMARQTM catheter. Methods: Thirty-seven patients (pts), (mean age 55 \uc2\ub1 12\uc2\ua0years; 28 males) were enrolled to perform PVI. All pts underwent PVI with the nMARQTM catheter. In 20 pts (group 1), we utilized ICE to guide nMARQTM catheter positioning at the PV ostia; in the other 17 pts (group 2), nMARQTM catheter was positioned at the PV ostia guided by fluoroscopy and TissueConnectTM technology. Results: Radiofrequency (RF) applications were significantly lower in group 1 compared to group 2 [left PVs: 6 (range 3 to 12) in group 1 and 12 (range 5 to 16) in group 2 (p < 0.001); right PVs: 7 (range 4 to 14) in group 1 and 10 (range 5 to 16) in group 2 (p = 0.04)]; similarly regarding the time of RF delivery [left PVs: 318 \uc2\ub1 194\uc2\ua0s in group 1 vs. 542 \uc2\ub1 104\uc2\ua0s in group 2 (p < 0.001); right PVs: 410 \uc2\ub1 270\uc2\ua0s in group 1 vs. 550 \uc2\ub1 156\uc2\ua0s in group 2 (p = 0.05)]. Fluoroscopy time (23 \uc2\ub1 9\uc2\ua0min vs. 28 \uc2\ub1 5\uc2\ua0min; p = 0.05), procedural time (83 \uc2\ub1 23\uc2\ua0min vs. 160 \uc2\ub1 42\uc2\ua0min; p < 0.001), and radiation dose (109 \uc2\ub1 20\uc2\ua0Gy/cm2 vs. 127 \uc2\ub1 29\uc2\ua0Gy/cm2; p = 0.04) were significantly lower in group 1 compared to group 2. Conclusion: ICE might be a useful tool to guide nMARQTM catheter position in the left atrium during atrial fibrillation (AF) ablation procedures