Key result
Half-normal saline-irrigated ablation after failed standard ablation provided 67.7% acute success for idiopathic OT-VA, but had higher recurrence than standard ablation (25.8% vs 12.4%; P=0.009).
Why the study?
Acute RFA failure in ventricular arrhythmias is partly attributed to inadequate lesion depth, making half-normal saline irrigation a promising strategy after failed standard ablation.
Does half-normal saline-irrigated ablation improve acute success and reduce recurrence in patients with idiopathic outflow tract ventricular arrhythmias after failed standard ablation?
Observational (n=160)
Does half-normal saline-irrigated ablation improve acute success and reduce recurrence in patients with idiopathic outflow tract ventricular arrhythmias after failed standard ablation?
Half-normal saline irrigation improves acute success rates for initially failed radiofrequency ablation of idiopathic outflow tract ventricular arrhythmias, though long-term recurrence remains higher than in initially successful cases.
Answers are grounded in this paper and cite their sources.
May offer acute success after failed ablation in idiopathic OT-VA; leaves open long-term durability versus standard ablation.
BACKGROUND: Acute failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VAs) occur in 10%-20% of patients and is partly attributed to inadequate lesion depth acquired with standard ablation protocols. Half-normal saline (HNS)-irrigation is a promising strategy to improve the success rate of VA ablation. OBJECTIVE: This study investigated the efficacy of HNS-irrigated ablation after a failed standard plain normal saline solution (PNSS)-irrigated ablation on idiopathic outflow tract ventricular arrhythmia (OT-VA). METHOD: This is a prospective observational study of consecutive patients undergoing RFA of idiopathic OT-VA comparing the efficacy of additional HNS-irrigated ablation for failed standard PNSS-irrigated ablation. Acute failure was defined as persistence of spontaneous VA or persistent inducibility of the clinical VA. RESULTS: Out of 160 OT-VA cases (51 ± 15-year-old, 62 males), 31 underwent HNS irrigation after a failed standard PNSS-irrigated ablation. The HNS group had a significantly longer procedure time (60.06 ± 43.83 vs 37.51 ± 33.40 minutes; P = .013) and higher radiation exposure (31.45 ± 20.24 vs 17.22 ± 15.25 minutes; P = .001) than the PNSS group but provided an additional acute success in 21 of 31 (67.7%) patients. Over a follow-up duration of 7.8 ± 4.6 months, 24 recurrences were identified, including 8 (25.8%) in the HNS and 16 (12.4%) in the PNSS group, with lower freedom from recurrence in the HNS group (log rank P = .009). No major complication was observed. CONCLUSION: HNS-irrigated ablation after failed standard PNSS-irrigated ablation is safe and additionally improves acute ablation success by 67.7% for idiopathic OT-VA but with a higher rate of recurrence on follow-up. Whether the application of HNS as initial irrigant could result in better outcome requires further investigation.
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Vicera et al. (2019) conducted an observational in Idiopathic outflow tract ventricular arrhythmia (OT-VA) (n=160). Half-normal saline (HNS)-irrigated ablation vs. Standard plain normal saline solution (PNSS)-irrigated ablation was evaluated on Recurrence of ventricular arrhythmia (p=.009). Half-normal saline-irrigated ablation after failed standard ablation provided 67.7% acute success for idiopathic OT-VA, but had higher recurrence than standard ablation (25.8% vs 12.4%; P=0.009).
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