Duty-cycled multi-electrode radiofrequency vs. conventional irrigated point-by-point radiofrequency ablation for recurrent atrial fibrillation: comparative 3-year data

Greef, Yves De; Buysschaert, Ian; Schwagten, Bruno; Stockman, Dirk; Tavernier, René; Duytschaever, Mattias

doi:10.1093/europace/eut398

Cited by 33 publications

(20 citation statements)

References 24 publications

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“…[5] In the latter study, the prolonged fluoroscopy times may be explained by additional CMC use in order to confirm complete PVI. Ablation with the nMARQ TM reveals comparable fluoroscopy times as indicated in literature for other ablation devices (Cryoballoon: 21 to 40 min [19], [30], [31], [34] ; PVAC 21 to 33 min [21], [32] ; single tip 16.6 to 24 min. [19], [25] A suggest learning curve shows a reduction of 51.5% to 64.5% of total fluoroscopy time .…”

Section: Procedural Resultssupporting

confidence: 68%

“…[5] Total procedure time in the latter study is likely highest due to four cavotricuspid isthmus ablations, and one ablation of roof dependent LA tachycardia which was performed during the course of PVI. Summarized, total procedure times reported from the nMARQ TM device compared well with procedure times obtained from other PVI ablation modalities (Cryoballoon: 136 to 371 min [20], [30], [31] ; PVAC: 121 to 137.1 min [32], [33] ; RF 140.9 to 165 min [19], [25] [18] Mean fluoroscopy times varied over a broad range, from 1.8 minutes [7] to 35.5 minutes. [5] In the latter study, the prolonged fluoroscopy times may be explained by additional CMC use in order to confirm complete PVI.…”

Section: Procedural Resultsmentioning

confidence: 84%

See 1 more Smart Citation

Pulmonary Vein Isolation with the Multipolar nMARQ™ Ablation Catheter: Efficacy And Safety In Acute And Long-Term Follow Up

Siebermair

Silver

Wakili

2017

Journal of Atrial Fibrillation

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Section: Procedural Resultssupporting

confidence: 68%

Section: Procedural Resultsmentioning

confidence: 84%

Pulmonary Vein Isolation with the Multipolar nMARQ™ Ablation Catheter: Efficacy And Safety In Acute And Long-Term Follow Up

Siebermair

Silver

Wakili

2017

Journal of Atrial Fibrillation

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“…On the other hand, nMARQ ® significantly increased the procedure time in the study of Wakili [24]. There was also a statistically significant reduction in total fluoroscopy time in most of the studies except for the studies by Beukema, Tivig (persistent AF subgroup), Looi, De Greef, Gal, and Rosso that no significant difference on total fluoroscopy times was observed between the 2 ablation strategies [12], [14], [15], [18], [20], [22]. Similar to procedure time, nMARQ ® significantly increased the fluoroscopy time in the study of Wakili [24].…”

Section: Resultsmentioning

confidence: 87%

“…The PVAC ® catheter applying duty-cycled bipolar/unipolar radiofrequency energy was used as an active comparator in 11 studies whereas the nMARQ ® catheter was studied in studies by Wakili and Rosso [15], [24]. Blanking period was 1 month in studies by Bulava and Bittner [16], [17], 3 months in remaining studies [13], [14], [15], [18], [19], [20], [21], [22], [23], [24]. Arrhythmia recurrence was investigated using 12-lead electrocardiogram in the study by Looi [20], 24-h Holter recording in the studies of Gal and Rosso [15], [22], 7-day Holter recording in the studies by Bulava and Wakili [16], [24], 24- to 96-h Holter recording in the study by Bittner [17], 24–48-h Holter monitoring in the studies by Choo and Khaykin [13], [19], 24- to 168-h Holter monitoring and 1 week AF alarm monitoring in the study of Beukema [18], 7-day ECG external loop recorder in the study by Tivig [12], 72-h Holter recording in the study of McCready [21], 1- to 7-day Holter recording or event recording in the study by De Greef [14], and implantable cardiac monitor and dual chamber pacemaker in the study by Podd [23].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Aras

Topaloğlu

Çay

et al. 2017

Indian Pacing and Electrophysiology Journal

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AimsPulmonary vein isolation is effective in reducing atrial fibrillation (AF) episodes. Previous studies suggest single-shot techniques are effective and safe for this purpose. Procedural and clinical outcomes were compared between multi-electrode and point-by-point radiofrequency ablations by performing a meta-analysis of all randomized and non-randomized studies.Methods and resultsSystematic reviews of MEDLINE and Cochrane Library databases were performed. Studies comparing procedural (procedure and fluoroscopy times) and clinical (AF recurrence) outcomes were included in the meta-analysis. A total of 13 clinical studies (5 randomized and 8 non-randomized) including 2152 patients met the inclusion criteria. In patients underwent multi-electrode ablation, there were significant reductions in both total procedure and fluoroscopy times, compared with point-by-point ablation (mean difference = −34.3 min [95% CI (−50.1 to −18.5)], p < 0.001 and mean difference = −7.1 min [95% CI (−12.0 to −2.2)], p < 0.01, respectively). These significances also continued in patients with paroxysmal AF. No such difference was observed in regard to AF recurrence between the 2 ablation strategies (RR = 0.90 [95% CI (0.80–1.01)], p = 0.066). This insignificance was also observed in patients with paroxysmal AF.ConclusionsIn a heterogeneous AF population, multi-electrode ablation is as effective as point-by-point ablation, with better procedural and fluoroscopy durations.

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“…present an important observational study cataloging damage to the esophagus and mediastinal structures during pulmonary vein isolation using this technology. Previous complications that are not specific to PVAC that have been reported include cerebral ischemic events, pulmonary vein stenosis, and asymptomatic mucosal lesions in the esophagus . A potential “antenna” effect of the thermal probe used to measure esophageal temperature has been hypothesized to increase the risk of such mucosal lesions.…”

mentioning

confidence: 99%

Friendly Fire-The Bane of Thermal Ablation

Padmanabhan

Asirvatham

2016

Pacing and Clinical Electrophysiology

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Successful invasive management of atrial fibrillation faces multilayered complex challenges for the operating electrophysiologist. Perhaps most feared and disconcerting is when we deliver thermal energy (radiofrequency [RF] or cryo energy) and manage to successfully permanently isolate the pulmonary veins without endovascular thromboemboli and eliminate atrial fibrillation only to find that collateral damage has occurred to the adjacent nontargeted structures, and as a result worsened a patient's quality of life.Avoiding friendly fire is made difficult by the complex anatomy surrounding the venoatrial junctions and indeed the left atrium, 1 and the very nature of thermal ablation itself. We do not yet have a way of knowing exactly how deep into the tissue thermally-mediated cell depth is occurring and thus constantly dangle on the tightrope between inadequate ablation and collateral damage.The pulmonary vein ablation catheter system with an over-the-wire mapping and ablation catheter along with a multichannel, duty-cycled RF generator (Ablation Frontiers Inc., Carlsbad, CA, USA) delivers ablation catheter energy in either unipolar or bipolar fashion with a fixed duty-cycle modulating the phase difference between the channels. The principal attraction of this system is to be able to simultaneously deliver ablative energy around the circumference of the pulmonary vein. The principal method of titration of energy is temperature control. As with all our other ablative methods, temperature measurement serves as a variable surrogate for actual depth of tissue, temperature increase, and lesion creation. In this issue of Pacing and Clinical Electrophysiology, Zellerhoff et al. 2 present an important observational study cataloging damage to the esophagus and mediastinal structures during pulmonary vein isolation using this technology.Previous complications that are not specific to PVAC that have been reported include cerebral ischemic events, 3-6 pulmonary vein stenosis, 7-9 and asymptomatic mucosal lesions in the esophagus. 7 A potential "antenna" effect of the thermal probe used to measure esophageal temperature has been hypothesized to increase the risk of such mucosal lesions. To date, no case has been reported of a clinically documented left atrial esophageal fistula after the use of the PVAC.A unique feature of the methodology used by Zellerhoff et al. 2 was radial endosonography used to detect lesions in the neighboring structures beyond the limited range of conventional surface endoscopy. Importantly, although surface mucosal lesions were present in only one patient, there were additional lesions seen in nine others that included mediastinal edema and periesophageal fluid accumulation. These findings are of potential clinical significance since left atrial esophageal fistula, once formed, is uniformly fatal without rapid and at times preemptive surgical management. 10-12

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Duty-cycled multi-electrode radiofrequency vs. conventional irrigated point-by-point radiofrequency ablation for recurrent atrial fibrillation: comparative 3-year data

Abstract: At 3 years follow-up, outcome after PVAC-guided PVI is comparable to conventional isolation by irrigated point-by-point RF ablation. In both strategies, the majority of recurrences occurred in the first year of ablation.

Cited by 33 publications

References 24 publications

Pulmonary Vein Isolation with the Multipolar nMARQ™ Ablation Catheter: Efficacy And Safety In Acute And Long-Term Follow Up

Pulmonary Vein Isolation with the Multipolar nMARQ™ Ablation Catheter: Efficacy And Safety In Acute And Long-Term Follow Up

Pulmonary vein isolation using multi-electrode radiofrequency vs conventional point-by-point radiofrequency ablation: A meta-analysis of randomized and non-randomized studies

Friendly Fire-The Bane of Thermal Ablation

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