Author + information
- Received April 16, 2018
- Revision received June 21, 2018
- Accepted June 21, 2018
- Published online August 29, 2018.
- Duy T. Nguyen, MDa,∗,
- Wendy S. Tzou, MDa,∗,
- Amneet Sandhu, MDa,
- Carola Gianni, MDb,
- Elad Anter, MDc,
- Roderick Tung, MDd,
- Miguel Valderrábano, MDe,
- Patrick Hranitzky, MDb,f,
- Kyoko Soeijma, MD, PhDg,
- Luis Saenz, MDh,
- Fermin C. Garcia, MDi,
- Usha B. Tedrow, MDj,
- John M. Miller, MDk,
- Edward P. Gerstenfeld, MDl,
- J. David Burkhardt, MDb,
- Andrea Natale, MDb and
- William H. Sauer, MDa,∗ ()
- aSection of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
- bTexas Cardiac Arrhythmia Institute, Austin, Texas
- cHarvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- dCenter for Arrhythmia Care, Heart and Vascular Center, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- eDivision of Cardiac Electrophysiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
- fSection of Cardiac Electrophysiology, WakeMed Heart and Vascular Center, Raleigh, North Carolina
- gDivision of Advanced Arrhythmia Management, Kyorin University Hospital, Tokyo, Japan
- hSection of Cardiac Electrophysiology, Fundacion CardioInfantil, Bogota, Colombia
- iSection of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, Pennsylvania
- jCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- kDepartment of Medicine, Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana
- lSection of Cardiac Electrophysiology, University of California – San Francisco, San Francisco, California
- ↵∗Address for correspondence:
Dr. William H. Sauer, Section of Cardiac Electrophysiology, University of Colorado, 12401 East 17th Avenue, B136, Aurora, Colorado 80045.
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.
↵∗ Drs. Nguyen and Tzou contributed equally to this paper and are joint first authors.
Drs. Sauer and Nguyen have received grants from Biosense Webster, CardioNXT, St. Jude Medical, Boston Scientific, and Medtronic; have a provisional patent on partially insulated focused catheter ablation; and have non-public equity interests/stock options in CardioNXT. Dr. Tzou has received personal fees from Boston Scientific, Medtronic, Biosense Webster, and Abbott. Dr. Anter has received personal fees from Biosense Webster and Boston Scientific. Dr. Valderrábano has received grants from Circa Scientific and Biosense Webster; and has received personal fees from Biosense Webster, Boston Scientific, and Abbott. Dr. Soejima has received personal fees from Abbott Japan. Dr. Tedrow has received personal fees from Abbott, Biosense Webster, Boston Scientific, and Medtronic. Dr. Miller has received personal fees from Medtronic, Boston Scientific, Biotronik, Abbott Electrophysiology, and Biosense Webster. Dr. Gerstenfeld has received grants and personal fees from Biosense-Webster and St Jude Medical; and has received personal fees from Boston Scientific. Dr. Burkhardt has received personal fees from Biosense Webster and Stereotaxis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest that they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 16, 2018.
- Revision received June 21, 2018.
- Accepted June 21, 2018.
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