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 ± 12 years; 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 ± 194 s in group 1 vs. 542 ± 104 s in group 2 (p < 0.001); right PVs: 410 ± 270 s in group 1 vs. 550 ± 156 s in group 2 (p = 0.05)]. Fluoroscopy time (23 ± 9 min vs. 28 ± 5 min; p = 0.05), procedural time (83 ± 23 min vs. 160 ± 42 min; p < 0.001), and radiation dose (109 ± 20 Gy/cm2 vs. 127 ± 29 Gy/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.