Author + information
- Received October 22, 2019
- Revision received January 23, 2020
- Accepted February 20, 2020
- Published online June 15, 2020.
- Cory M. Tschabrunn, PhDa,b,∗ (, )
- Naga Venkata K. Pothineni, MDa,
- William H. Sauer, MDc,
- Daniel Doynow, MPHa,
- Jonathan Salas, BSa,
- Ting-Wei Liaoa,
- Pasquale Santangeli, MD, PhDa,
- Jeffrey Arkles, MDa,
- Matthew C. Hyman, MD, PhDa,
- David S. Frankel, MDa,
- Gregory E. Supple, MDa,
- Fermin C. Garcia, MDa,
- Saman Nazarian, MD, PhDa,
- Sanjay Dixit, MDa,
- Andrew E. Epstein, MDa,
- Robert D. Schaller, DOa,
- David J. Callans, MDa and
- Francis E. Marchlinski, MDa
- aCardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bPenn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania
- cCardiac Arrhythmia Service, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Cory M. Tschabrunn, Cardiac Electrophysiology, University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives This study investigated the impact of the type of catheter irrigant used during delivery of radiofrequency ablation.
Background The use of half-normal saline (HNS) as an irrigant has been suggested as a method for increasing ablation lesion size but has not been rigorously studied in the beating heart or the use of a low-flow irrigation catheter.
Methods Sixteen swine underwent left ventricular mapping and ablation using either normal saline (NS) (group 1: n = 9) or half-normal saline (HNS) (group 2: n = 7). All lesions were delivered using identical parameters (40 W with 10-second ramp, 30-second duration, 15 ml/min flow, and 8- to14-g target contact force). An occurrence of steam pop, catheter char, or thrombus was assessed using intracardiac echocardiography and catheter inspection following each application. Lesion depth, width, and area were measured using electronic calibers.
Results A total of 109 lesions were delivered in group 1 and 77 in group 2. There were significantly more steam pops in group 2 (32 of 77 [42%] vs. 24 of 109 [22%], respectively). The frequencies of catheter tip char were similar (group 1: 9 of 109 [8%] vs. group 2: 10 of 77 [13%]; p = 0.29). Lesion depths, widths, and areas also were similar in both groups.
Conclusions The use of an HNS irrigant using a low-flow open irrigated ablation catheter platform results in more tissue heating due to higher radiofrequency current delivery directed to tissue, but this can lead to higher rate of steam pops. In this in vivo porcine beating-heart model, the use of HNS does not appear to significantly increase lesion size in normal myocardium despite evidence of increased radiofrequency heating.
This project (IIS-488) was supported by the Investigator-Initiated Study Program of Biosense Webster, Inc., and the Winkelman Family Fund in Cardiovascular Innovation. Dr. Marchlinski has received research support from Biosense Webster, Inc. Dr. Nazarian has received research support from Biosense Webster, ImriCor, and Siemens; and is a consultant for CardioSolv and Circle Software. Dr. Tschabrunn has received research support from Biosense Webster, Attune Medical, and Baylis Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest 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 October 22, 2019.
- Revision received January 23, 2020.
- Accepted February 20, 2020.
- 2020 American College of Cardiology Foundation
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