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Hasegawa K, Yoneda ZT, Powers EM, Tokutake K, Kurata M, Richardson TD, Montgomery JA, Shen S, Estrada JC, Saavedra PJ, Emerson A, Walker ML, Tandri H, Michaud GF, Kanagasundram AN, Stevenson WG. Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation. Europace 2024; 26:euae018. [PMID: 38367008 PMCID: PMC10898929 DOI: 10.1093/europace/euae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 02/19/2024] Open
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.
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Affiliation(s)
- Kanae Hasegawa
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Zachary T Yoneda
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Edward M Powers
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Kenichi Tokutake
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Masaaki Kurata
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Travis D Richardson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Jay A Montgomery
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Sharon Shen
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Juan C Estrada
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Pablo J Saavedra
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Amy Emerson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Marilyn L Walker
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Harikrishna Tandri
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Gregory F Michaud
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Arvindh N Kanagasundram
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
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