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Aritmologia in Campania

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"Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation"

Giuseppe Stabile, Matteo Anselmino, Ezio Soldati, Ermengildo De Ruvo, Francesco Solimene, Assunta Iuliano, Luigi Sciarra, Maria Grazia Bongiorni, Leonardo Calò, Fiorenzo Gaita

Abstract

Purpose Left atrial volume (LA) and pulmonary vein (PV)anatomy may potentially relate to technical challenges inachieving stable and effective catheter position in case of atrialfibrillation (AF) ablation by means of Bone-shot^ catheters.The aim of this study was to investigate whether LA volumeand PV anatomy, evaluated by computed tomography (CT) ormagnetic resonance (MR) prior to ablation, predict acute andmidterm outcome of AF ablation by nMARQ™.Methods We included 75 patients (mean age 58 ± 11 years,67 % male) with symptomatic paroxysmal AF. All patientsunderwent CT/MR scanning prior to catheter ablation to eval-uate LA volume and PV anatomy. All the patients underwentPV isolation by nMARQ™, an open-irrigated mapping andradiofrequency (RF) decapolar ablation catheter. Ablation wasguided by electroanatomic mapping allowing RF energy de-livery in the antral region of PVs from ten irrigated electrodessimultaneously.Results Mean LA volume was 75 ± 40 ml. A normal anatomy(4 PVs) was documented in 40 (53 %) patients and abnormalanatomy (common truncus or accessory PVs) in 35 patients.Mean procedural and fluoroscopy times were 94 ± 55 and 8 ± 5 min, respectively, without significant differences amongpatients with normal or abnormal anatomy (92 ± 45 vs 95 ±64 min, p = 0.85 and 6 ± 3 vs 8 ± 4 min, p = 0.65, respective-ly). Mean ablation time was 14 ± 3 min, and 99 % of thetargeted veins were isolated with a mean of 23 ± 5 RF pulsesper patient. After a mean follow- up of 17 ± 8 months, 23(31 %) patients had an atrial arrhythmia recurrence. NeitherLA volume nor PV anatomy was a predictor of outcome.Conclusions LA volume and PV anatomy did not affect pro-cedural data and outcome in patients who underwent PV iso-lation by an open-irrigated mapping and RF decapolar abla-tion catheter.

Keywords
Atrial fibrillation.Catheter ablation.Multielectrode ablation catheter.Anatomy.Safety.Midtermoutcome

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