Abstract
Purpose
Left atrial volume (LA) and pulmonary vein (PV) anatomy may potentially relate to technical challenges in achieving stable and effective catheter position in case of atrial fibrillation (AF) ablation by means of “one-shot” catheters. The aim of this study was to investigate whether LA volume and PV anatomy, evaluated by computed tomography (CT) or magnetic resonance (MR) prior to ablation, predict acute and midterm outcome of AF ablation by nMARQ™.
Methods
We included 75 patients (mean age 58 ± 11 years, 67 % male) with symptomatic paroxysmal AF. All patients underwent CT/MR scanning prior to catheter ablation to evaluate LA volume and PV anatomy. All the patients underwent PV isolation by nMARQ™, an open-irrigated mapping and radiofrequency (RF) decapolar ablation catheter. Ablation was guided by electroanatomic mapping allowing RF energy delivery in the antral region of PVs from ten irrigated electrodes simultaneously.
Results
Mean LA volume was 75 ± 40 ml. A normal anatomy (4 PVs) was documented in 40 (53 %) patients and abnormal anatomy (common truncus or accessory PVs) in 35 patients. Mean procedural and fluoroscopy times were 94 ± 55 and 8 ± 5 min, respectively, without significant differences among patients with normal or abnormal anatomy (92 ± 45 vs 95 ± 64 min, p = 0.85 and 6 ± 3 vs 8 ± 4 min, p = 0.65, respectively). Mean ablation time was 14 ± 3 min, and 99 % of the targeted veins were isolated with a mean of 23 ± 5 RF pulses per patient. After a mean follow-up of 17 ± 8 months, 23 (31 %) patients had an atrial arrhythmia recurrence. Neither LA volume nor PV anatomy was a predictor of outcome.
Conclusions
LA volume and PV anatomy did not affect procedural data and outcome in patients who underwent PV isolation by an open-irrigated mapping and RF decapolar ablation catheter.
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This study was approved by the institutional review committees, and all patients signed informed consents. The principle outlined in latest update of the Declaration of Helsinki was followed.
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Appendix
Appendix
Participating centers:
Clinica Mediterranea, Napoli (Giuseppe Stabile, Assunta Iuliano, Alfonso Panella); Policlinico Casilino, Roma (Leonardo Calò, Gildo De Ruvo, Luigi Sciarra); Azienda Ospedaliero Universitaria Pisana, Pisa (Ezio Soldati, Maria Grazia Bongiorni); Dipartimento di Scienze Mediche, Università di Torino (Matteo Anselmino, Federico Ferraris, Fiorenzo Gaita); Clinica Montevergine, Mercogliano (AV) (Francesco Solimene).
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Stabile, G., Anselmino, M., Soldati, E. et al. Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 48, 201–207 (2017). https://doi.org/10.1007/s10840-016-0189-3
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DOI: https://doi.org/10.1007/s10840-016-0189-3