Pulmonary vein isolation with a new multipolar irrigated radiofrequency ablation catheter (nMARQ™): feasibility, acute and short-term efficacy, safety, and impact on postablation silent cerebral ischemia.

BACKGROUND: Simultaneous multipolar ablation catheters have been proposed to simplify pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). Recently, a new multipolar irrigated radiofrequency (RF) ablation catheter (nMARQ™, Biosense Webster Inc., Diamond Bar, CA, USA) combining both 3-dimensional electroanatomic mapping and multipolar open-irrigated ablation capability has been developed. Aim of our study was to assess feasibility, acute and short-term success and safety of PVI by the use of this new technology with particular regard to the incidence of postablation silent cerebral ischemia (SCI). METHODS AND RESULTS: Twenty-five patients (76% males; age 57 ± 13 years) with paroxysmal AF underwent PVI using the nMARQ™ catheter. PVI, confirmed by Lasso catheter mapping, was achieved in 100 out of 102 pulmonary veins (98%) identified, and final PVI was obtained in 24 out of 25 (96%) patients. The overall concordance between Lasso and nMARQ™ signals in demonstrating PVI was 78%. No major procedural complications occurred and no patient suffered SCI, on the basis of cerebral magnetic resonance imaging performed before and after the procedure. Following a 6-month follow-up, 17/25 (68%) patients remained free from AF without antiarrhythmic drugs. CONCLUSIONS: In our preliminary experience, PVI with nMARQ™ catheter appears to be feasible and safe, without incidence of SCI. Long-term clinical efficacy has to be evaluated in further studies.

Evaluation of time course and predicting factors of progression of paroxysmal or persistent atrial fibrillation to permanent atrial fibrillation.

BACKGROUND: To evaluate time course and predictors of progression of paroxysmal or persistent atrial fibrillation (AF) to permanent AF. METHODS AND RESULTS: We included 460 patients referred for paroxysmal (n = 337) or persistent (n = 123) AF between 1994 and 2012. Mean follow-up was 13.2 ± 6.5 years. AF progression rate was 3.7% per year, 19.7% at 5 years, and 38.1% at 10 years. Lone AF was diagnosed in 217 patients (47%). Predictors of permanent AF were: age, persistent AF, left atrial (LA) size, left ventricular-fractional shortening (LV-FS), lack of antiarrhythmic (AA) drugs, VVI pacing (P < 0.001 for all), and valvular disease (P < 0.02). Independent predictors were age (P < 0.001), persistent AF (P < 0.001), LA diameter (P < 0.005), lack of AA drugs (P < 0.005), and VVI pacing (P < 0.01). When adjusted at means of covariates, persistent AF and age >75 years remained highly significant (P < 0.01). LA dimension >50 mm was highly significant at univariate model (P < 0.001) but to a lesser extent when adjusted (P < 0.05). In patients with paroxysmal AF-with age <75 years-on AA drugs, progression rate to permanent AF was 6.5% at 5 years and 23.7% at 10 years. Among four predictors (age, LA size, LV-FS, and VVI pacing), only age (P < 0.01) and LA size (P < 0.005) remained independently significant, but LA size was not significant when adjusted. CONCLUSIONS: Progression to permanent AF is a slow process. Aging, LA size, VVI pacing, lack of AA therapy, and a persistent form of AF independently increased the progression to permanent AF.

An unusual combination of possible causes of sudden death imaged by 64-slice computed tomography.

Hypertrophic cardiomyopathy and anomalous origin of the coronary arteries are important causes of sudden cardiac death in the young, for which several diagnostic imaging modalities are currently available. We report the case of a young sudden cardiac death survivor in whom the unusual coexistence of hypertrophic cardiomyopathy and anomalous origin of the left circumflex artery was demonstrated using 64-slice computed tomography.