Key result
Use of the ThermoCool ablation catheter during paroxysmal atrial fibrillation ablation resulted in significantly higher saline infusion (1277 vs 697 ml) and post-ablation weight gain compared to the Surround Flow catheter.
Why the study?
The clinical consequences of large saline infusions during radiofrequency catheter ablation for paroxysmal atrial fibrillation have not been systematically studied.
Does the use of ThermoCool ablation catheter compared to Surround Flow ablation catheter alter post-ablation fluid balance and electrolytes in patients with paroxysmal atrial fibrillation?
Observational (n=47)
No
Does the use of ThermoCool ablation catheter compared to Surround Flow ablation catheter alter post-ablation fluid balance and electrolytes in patients with paroxysmal atrial fibrillation?
Higher saline volume infusion during AF ablation with TCAC leads to significant fluid shifts and electrolyte disturbances requiring diuresis, though without increasing short-term morbidity.
BACKGROUND: Radio-Frequency ablation (RFA) to achieve pulmonary vein isolation (PVI) remains mainstay therapy for symptomatic paroxysmal atrial fibrillation (PAF). The clinical consequences of large saline infusions during AF ablation have not been systematically studied. We utilized the differential flow-rates of the two commercially available ablation catheters (AC): 'ThermoCool' (TCAC) and 'Surround Flow' (SFAC) from Biosense-Webster to evaluate the clinical impact of the saline infused in the immediate post-ablation period. METHODS: Consecutive charts of PAF patients between 18 and 81 years who underwent RFA procedure at a tertiary care hospital were reviewed. RESULTS: Forty-seven patients were included in the study (33Males, 65±11years, LVEF 58±7% and left atrial diameter 44±7.5mm, 23TCAC-use). The saline volume infused through the AC was significantly higher with TCAC vs SFAC use (1277±316vs697±299 ml; p<0.001), with no difference in volume infused from other sources, total procedure or RFA times (p>0.05). This led to significant increase in post-ablation weight gain (96±23 vs 97.5±24kg; p=0.002), furosemide usage (39% vs 0%; p=0.0006), urine production (120±79 vs 63±31ml/hr; p=0.003) and post-RFA potassium reduction (4.4±0.42 vs 4±0.32mmol/l; p<0.001) with TCAC use. Significant post-RFA reduction in magnesium, calcium and creatinine, associated hyperchloremic metabolic acidosis and a modest QTc prolongation were also observed with use of both ACs albeit only moderate to weakly correlated with saline volume infused through the AC. No clinical adverse outcomes were encountered. CONCLUSIONS: Higher saline-volume infusing AC use in PAF ablation causes significant post-ablation weight gain despite higher furosemide use, larger urine production and associated post-RFA potassium reduction without increasing morbidity in lower acuity patients. Furthermore, an array of post-ablation electrolyte disturbances causes a modest and clinically insignificant QTc prolongation.
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Nagesh Chopra (2018) conducted an observational in Paroxysmal Atrial Fibrillation (n=47). ThermoCool ablation catheter (TCAC) vs. Surround Flow ablation catheter (SFAC) was evaluated on Saline volume infused through the ablation catheter (ml) (p=<0.001). Use of the ThermoCool ablation catheter during paroxysmal atrial fibrillation ablation resulted in significantly higher saline infusion (1277 vs 697 ml) and post-ablation weight gain compared to the Surround Flow catheter.
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