A Randomized Comparison of Circular versus Single Point-By-Point Pulmonary Vein Isolation

Introduction: Point-by-point standard ablation using single-tip (conventional) catheter is the main current technique for pulmonary vein isolation (PVI) but it can be challenging. A circular, multielectrode, mapping and ablation catheter (nMARQ) may provide faster PVI. Methods: We designed a randomized comparison between circular versus conventional PVI with the primary end point of reconnection: acutely, in the index procedure, and at 3 months, at the time of a systematic repeat procedure. Results: Eighty-one patients randomized to circular (nMARQ n = 38) versus conventional (Thermocool Navistar n = 43) underwent PVI for paroxysmal atrial fibrillation. Both groups had similar characteristics: nMARQ age 61 ± 11 years (84% male) and TC age 60 ± 9 years (68% male). NMARQ procedures were shorter (RF and procedure duration), with fewer RIPV reconnections, both acutely and at 3 months (index: 1 (3%) versus 7 (16%), p = 0.044, redo: 21(18%) versus 36 (28%), p = 0.05). Patients ablated with the circular catheter also had shorter repeat procedures suggesting more discrete PV reconnections (nMRAQ: 142 ± 56 versus TC: 186 ± 76 minutes, p = 0.001). At 12 months follow up, 77% of patients in nMARQ group and 79% in TC group were in SR (p = 0.852). No major procedural complications were observed. Conclusion: This randomized study shows that nMARQ catheter is 3 times faster in isolating the PVs, with shorter RF and procedure time. It is also associated with fewer PV reconnections at 3 months. NMARQ appeared to be safe with no major procedural complications. Keywords: Paroxysmal atrial fibrillation; Pulmonary vein isolation; Circular (nMARQ) catheter ablation; Single point-by-point (Thermocool catheter ablation); Reconnection rat