Journal article
Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation
Europace, Vol.26(2), euae018
02/01/2024
DOI: 10.1093/europace/euae018
PMCID: PMC10898929
PMID: 38367008
Abstract
Aims
Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated RF ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrigant were used for normal saline (NS) and HNS but could increase risks related to steam pops and lesion size. This study aims to assess periprocedural complications and acute ablation outcome of ventricular arrhythmias ablation with HNS.
Methods and results
Prospective assessment of outcomes was performed in 1024 endocardial and/or epicardial RF ablation procedures in 935 consecutive patients (median age 64 years, 71.2% men, 73.4% cardiomyopathy, 47.2% sustained ventricular tachycardia). Half-normal saline was selected at the discretion of the treating physician. Radiofrequency ablation power was generally titrated to a ≤15 Ω impedance fall with intracardiac echocardiography monitoring. Half-normal saline was used in 900 (87.9%) and NS in 124 (12.1%) procedures. Any adverse event within 30 days occurred in 13.0% of patients treated with HNS RF ablation including 4 (0.4%) strokes/transient ischaemic attacks and 34 (3.8%) pericardial effusions requiring treatment (mostly related to epicardial access). Two steam pops with perforation required surgical repair (0.2%). Patients who received NS irrigation had less severe disease and arrhythmias. In multivariable models, adverse events and acute success of the procedure were not related to the type of irrigation.
Conclusion
Half-normal saline irrigation RF ablation with power guided by impedance fall and intracardiac echocardiography has an acceptable rate of complications and acute ablation success while administering half of the saline load expected for NS irrigation.
Details
- Title: Subtitle
- Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation
- Creators
- Kanae Hasegawa - Vanderbilt University Medical CenterZachary T Yoneda - Vanderbilt University Medical CenterEdward M Powers - Vanderbilt University Medical CenterKenichi Tokutake - Vanderbilt University Medical CenterMasaaki Kurata - Vanderbilt University Medical CenterTravis D Richardson - Vanderbilt University Medical CenterJay A Montgomery - Vanderbilt University Medical CenterSharon Shen - Vanderbilt University Medical CenterJuan C Estrada - Vanderbilt University Medical CenterPablo J Saavedra - Vanderbilt University Medical CenterAmy Emerson - Vanderbilt University Medical CenterMarilyn L Walker - Vanderbilt University Medical CenterHarikrishna Tandri - Vanderbilt University Medical CenterGregory F Michaud - Vanderbilt University Medical CenterArvindh N Kanagasundram - Vanderbilt University Medical CenterWilliam G Stevenson - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- Europace, Vol.26(2), euae018
- Publisher
- Oxford University Press (OUP)
- DOI
- 10.1093/europace/euae018
- PMID
- 38367008
- PMCID
- PMC10898929
- ISSN
- 1099-5129
- eISSN
- 1532-2092
- Grant note
- International Rotary Fellowship of Healthcare ProfessionalsJapanese Heart Rhythm Society: GG2099197
K.H.: International Rotary Fellowship of Healthcare Professionals. K.T. and M.K.: scholarship from the Japanese Heart Rhythm Society (grant number: GG2099197).
- Language
- Japanese
- Date published
- 02/01/2024
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984802503202771
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