Key result
Irrigation of RF ablation catheters with half-normal saline yielded shorter RF times but no significant difference in 1-year recurrence of atrial arrhythmia (HR 1.17; 95% CI 0.66-2.06).
Why the study?
By increasing the efficacy of RF energy-mediated lesion formation, half-normal saline irrigant has the potential to reduce procedural times and improve outcomes in AF ablation.
Does half-normal saline irrigation improve procedural efficiency and reduce atrial arrhythmia recurrence compared to normal saline in patients undergoing first-time RF ablation for AF?
RCT (n=99)
Double-blind
1:1
Does half-normal saline irrigation improve procedural efficiency and reduce atrial arrhythmia recurrence compared to normal saline in patients undergoing first-time RF ablation for AF?
Using half-normal saline for open-irrigated RF ablation in AF reduces RF time but does not significantly improve 1-year freedom from atrial arrhythmias compared to normal saline.
Answers are grounded in this paper and cite their sources.
Half-normal saline shortens RF time without lowering recurrence; challenges efficiency-focused lesion strategies for improving AF ablation durability.
BACKGROUND: The creation of effective and permanent lesions is a crucial factor in determining the success rate of atrial fibrillation (AF) ablation. By increasing the efficacy of radiofrequency (RF) energy-mediated lesion formation, half-normal saline (HNS) as an irrigant for open-irrigated ablation catheters has the potential to reduce procedural times and improve acute and long-term outcomes. METHODS: This is a double-blind randomized clinical trial of 99 patients undergoing first-time RF catheter ablation for AF. Patients enrolled were randomly assigned in a 1:1 fashion to perform ablation using HNS or normal saline (NS) as an irrigant for the ablation catheter. RESULTS: The use of HNS is associated with shorter RF times (26 vs. 33 min; p = .02) with comparable procedure times (104 vs. 104 min). The rate of acute pulmonary vein reconnections (16% vs. 18%) was comparable, with a median of 1 vein reconnection in the HNS arm versus 2 in the NS arm. There was no difference in procedure-related complications, including the incidence of postprocedural hyponatremia when using HNS. Over the 1-year follow-up, there is no significant difference between the HNS and NS with respect to the recurrence of any atrial arrhythmia (off antiarrhythmic drugs [AAD]: 47% vs. 52%; hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 0.66-2.06; off/on AAD: 66% vs. 66%, HR: 1.06, 95% CI: 0.53-2.12), with a potential benefit of using HNS when considering the paroxysmal AF cohort (on/off AAD 73% vs. 62%, HR: 0.72, 95% CI: 0.19-2.70). CONCLUSIONS: In a mixed cohort of patients undergoing first-time AF ablation, irrigation of open-irrigated RF ablation catheters with HNS is associated with shorter RF times, with a comparably low rate of procedure-related complications. In the long term, there is no significant difference with respect to the recurrence of any atrial arrhythmia. Larger studies with a more homogeneous population are necessary to determine whether HNS improves clinical outcomes.
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Gianni et al. (2021) conducted an RCT in Atrial fibrillation (n=99). Half-normal saline (HNS) irrigation vs. Normal saline (NS) irrigation was evaluated on Recurrence of any atrial arrhythmia (off antiarrhythmic drugs) (HR 1.17, 95% CI 0.66-2.06). Irrigation of RF ablation catheters with half-normal saline yielded shorter RF times but no significant difference in 1-year recurrence of atrial arrhythmia (HR 1.17; 95% CI 0.66-2.06).
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