Prospective Multicenter Experience With Cooled Radiofrequency Ablation Using High Impedance Irrigant to Target Deep Myocardial Substrate Refractory to Standard Ablation

Duy T. Nguyen, Wendy S. Tzou, Amneet Sandhu, Carola Gianni, Elad Anter, Roderick Tung, Miguel Valderrábano, Patrick Hranitzky, Kyoko Soeijma, Luis Saenz, Fermin C. Garcia, Usha B. Tedrow, John Miller, Edward P. Gerstenfeld, J. David Burkhardt, Andrea Natale, William H. Sauer

Research output: Contribution to journalArticle

23 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1176-1185
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume4
Issue number9
DOIs
StatePublished - Sep 1 2018

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Electric Impedance
Ventricular Premature Complexes
Ventricular Tachycardia
Cardiac Arrhythmias
compound A 12
Steam
Electrolytes
Myocardium
Safety
Therapeutics

Keywords

  • ablation
  • radiofrequency
  • ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prospective Multicenter Experience With Cooled Radiofrequency Ablation Using High Impedance Irrigant to Target Deep Myocardial Substrate Refractory to Standard Ablation. / Nguyen, Duy T.; Tzou, Wendy S.; Sandhu, Amneet; Gianni, Carola; Anter, Elad; Tung, Roderick; Valderrábano, Miguel; Hranitzky, Patrick; Soeijma, Kyoko; Saenz, Luis; Garcia, Fermin C.; Tedrow, Usha B.; Miller, John; Gerstenfeld, Edward P.; Burkhardt, J. David; Natale, Andrea; Sauer, William H.

In: JACC: Clinical Electrophysiology, Vol. 4, No. 9, 01.09.2018, p. 1176-1185.

Research output: Contribution to journalArticle

Nguyen, DT, Tzou, WS, Sandhu, A, Gianni, C, Anter, E, Tung, R, Valderrábano, M, Hranitzky, P, Soeijma, K, Saenz, L, Garcia, FC, Tedrow, UB, Miller, J, Gerstenfeld, EP, Burkhardt, JD, Natale, A & Sauer, WH 2018, 'Prospective Multicenter Experience With Cooled Radiofrequency Ablation Using High Impedance Irrigant to Target Deep Myocardial Substrate Refractory to Standard Ablation', JACC: Clinical Electrophysiology, vol. 4, no. 9, pp. 1176-1185. https://doi.org/10.1016/j.jacep.2018.06.021
Nguyen, Duy T. ; Tzou, Wendy S. ; Sandhu, Amneet ; Gianni, Carola ; Anter, Elad ; Tung, Roderick ; Valderrábano, Miguel ; Hranitzky, Patrick ; Soeijma, Kyoko ; Saenz, Luis ; Garcia, Fermin C. ; Tedrow, Usha B. ; Miller, John ; Gerstenfeld, Edward P. ; Burkhardt, J. David ; Natale, Andrea ; Sauer, William H. / Prospective Multicenter Experience With Cooled Radiofrequency Ablation Using High Impedance Irrigant to Target Deep Myocardial Substrate Refractory to Standard Ablation. In: JACC: Clinical Electrophysiology. 2018 ; Vol. 4, No. 9. pp. 1176-1185.
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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.",
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AU - Nguyen, Duy T.

AU - Tzou, Wendy S.

AU - Sandhu, Amneet

AU - Gianni, Carola

AU - Anter, Elad

AU - Tung, Roderick

AU - Valderrábano, Miguel

AU - Hranitzky, Patrick

AU - Soeijma, Kyoko

AU - Saenz, Luis

AU - Garcia, Fermin C.

AU - Tedrow, Usha B.

AU - Miller, John

AU - Gerstenfeld, Edward P.

AU - Burkhardt, J. David

AU - Natale, Andrea

AU - Sauer, William H.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

KW - ablation

KW - radiofrequency

KW - ventricular arrhythmias

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