Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation

Background Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models when compared to normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS versus NS irrigation for typical AFL ablation. Methods Sixty-patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops and AFL recurrence during follow-up. Results Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5±8.2 years, 20% were female and 32% had atrial fibrillation prior to being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4±4.4 minutes versus 7.6±4.5 minutes respectively, p=0.15). There was a trend to less acute reconnection in the HNS group compared to NS (13.3% versus 26.6%, p=0.46). Steam pops occurred in 4 patients using HNS versus none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS, p=0.5). There was no difference in time to recurrence (7.6±6.9 vs. 4.9±4.5 months, p=0.6). Conclusion In this small pilot RCT, there was no significant difference between HNS and NS for CTI ablation, however, HNS may increase the incidence of steam pops.