Duy T Nguyen1, Wendy S Tzou1, Amneet Sandhu1, Carola Gianni2, Elad Anter3, Roderick Tung4, Miguel Valderrábano5, Patrick Hranitzky6, Kyoko Soeijma7, Luis Saenz8, Fermin C Garcia9, Usha B Tedrow10, John M Miller11, Edward P Gerstenfeld12, J David Burkhardt2, Andrea Natale2, William H Sauer13. 1. Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado. 2. Texas Cardiac Arrhythmia Institute, Austin, Texas. 3. Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Center for Arrhythmia Care, Heart and Vascular Center, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. 5. Division of Cardiac Electrophysiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas. 6. Texas Cardiac Arrhythmia Institute, Austin, Texas; Section of Cardiac Electrophysiology, WakeMed Heart and Vascular Center, Raleigh, North Carolina. 7. Division of Advanced Arrhythmia Management, Kyorin University Hospital, Tokyo, Japan. 8. Section of Cardiac Electrophysiology, Fundacion CardioInfantil, Bogota, Colombia. 9. Section of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, Pennsylvania. 10. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. 11. Department of Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana. 12. Section of Cardiac Electrophysiology, University of California - San Francisco, San Francisco, California. 13. Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado. Electronic address: william.sauer@ucdenver.edu.
Abstract
OBJECTIVES: This study sought to evaluate the efficacy and safety of using half-normal saline (HNS) as the cooling radiofrequency ablation (RFA) irrigant among patients who had failed prior, standard RFA. BACKGROUND: Effective control of ventricular arrhythmias that arise from mid-myocardium may be refractory to standard RFA. Recent data suggest that delivering fluid with decreased ionic concentration during open-irrigated RFA can produce deeper RFA lesions. METHODS: A 12-center prospective analysis was performed of all ablations using HNS for the treatment of ventricular arrhythmias (premature ventricular complex [PVC]/ventricular tachycardia [VT]) refractory to standard ablation with normal saline irrigant. RESULTS: HNS RFA was used clinically to target 94 PVC/VTs refractory to standard ablation. Acute success was achieved in 78 of 94 (83%), with longer-term success occurring in 78 subjects after a mean follow-up of 6.1 ± 6.7 months (range, 3.0 to 25.2 months). Steam pops were observed among 12 (12.6%) patients. There were no significant changes in electrolytes measured before and after the use of HNS, and there were no complications related to HNS use. CONCLUSIONS: The use of HNS instead of normal saline irrigant during high-power delivery targeting deep myocardial substrate is safe and effective. PVC/VT sources previously unaffected by standard ablation may be successfully ablated with improved efficiency of radiofrequency delivery using HNS.
OBJECTIVES: This study sought to evaluate the efficacy and safety of using half-normal saline (HNS) as the cooling radiofrequency ablation (RFA) irrigant among patients who had failed prior, standard RFA. BACKGROUND: Effective control of ventricular arrhythmias that arise from mid-myocardium may be refractory to standard RFA. Recent data suggest that delivering fluid with decreased ionic concentration during open-irrigated RFA can produce deeper RFA lesions. METHODS: A 12-center prospective analysis was performed of all ablations using HNS for the treatment of ventricular arrhythmias (premature ventricular complex [PVC]/ventricular tachycardia [VT]) refractory to standard ablation with normal saline irrigant. RESULTS: HNS RFA was used clinically to target 94 PVC/VTs refractory to standard ablation. Acute success was achieved in 78 of 94 (83%), with longer-term success occurring in 78 subjects after a mean follow-up of 6.1 ± 6.7 months (range, 3.0 to 25.2 months). Steam pops were observed among 12 (12.6%) patients. There were no significant changes in electrolytes measured before and after the use of HNS, and there were no complications related to HNS use. CONCLUSIONS: The use of HNS instead of normal saline irrigant during high-power delivery targeting deep myocardial substrate is safe and effective. PVC/VT sources previously unaffected by standard ablation may be successfully ablated with improved efficiency of radiofrequency delivery using HNS.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Ayelet Shapira-Daniels; Michael Barkagan; Markus Rottmann; Jakub Sroubek; Derin Tugal; Michael A Carlozzi; James W McConville; Alfred E Buxton; Elad Anter Journal: Circ Arrhythm Electrophysiol Date: 2019-06
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Babak Nazer; David Giraud; Yan Zhao; James Hodovan; Miriam R Elman; Ahmad Masri; Edward P Gerstenfeld; Jonathan R Lindner Journal: Heart Rhythm Date: 2020-12-29 Impact factor: 6.343