Catheter Ablation Using Half-Normal Saline and Dextrose Irrigation in an Ovine Ventricular Model

Bennett, Richard G.; Campbell, Timothy; Turnbull, Samual; Kumar, Saurabh

doi:10.1016/j.jacep.2021.05.002

Cited by 26 publications

(31 citation statements)

References 10 publications

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“…While this approach did shorten RF times during atrial fibrillation (AF) ablation, clinical outcomes, and arrhythmia recurrence rates were not significantly different. Bennett et al 17 demonstrated similar findings in an animal model using half saline and 5% dextrose (which has even higher resistance)—importantly, steam pops were more common in the half saline and dextrose arms (5% vs. 11% and 35%, respectively).…”

Section: Established Modifiable Determinants Of Rf Lesion Formationmentioning

confidence: 68%

Local impedance for the optimization of radiofrequency lesion delivery: A review of bench and clinical data

Chu

Calvert

Futyma

et al. 2021

Cardiovasc electrophysiol

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Introduction Radiofrequency catheter ablation is a cornerstone of treatment for many cardiac arrhythmias. Progression in three‐dimensional mapping and contact‐force sensing technologies have improved our capability to achieve success, but challenges still remain. Methods In this article, we discuss the importance of overall circuit impedance in radiofrequency lesion formation. This is followed by a review of the literature regarding recently developed “local impedance” technology and its current and future potential applications and limitations, in the context of established surrogate markers currently used to infer effective ablation. Results We discuss the role of local impedance in assessing myocardial substrate, as well as its role in clinical studies of ablation. We also discuss safety considerations, limitations and ongoing research. Conclusion Local impedance is a novel tool which has the potential to tailor ablation in a manner distinct from other established metrics.

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Section: Established Modifiable Determinants Of Rf Lesion Formationmentioning

confidence: 68%

Local impedance for the optimization of radiofrequency lesion delivery: A review of bench and clinical data

Chu

Calvert

Futyma

et al. 2021

Cardiovasc electrophysiol

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“…[ 94 ] Dextrose irrigation has also been trialled in an ovine ventricular model with lesion sizes comparable to those achieved with half normal saline, both of which were larger in volume than normal saline irrigated lesions. [ 95 ]…”

Section: Alternative Irrigation Solutionsmentioning

confidence: 99%

Contemporary Management of Complex Ventricular Arrhythmias

Wiles

Waight

et al. 2022

Arrhythm Electrophysiol Rev

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Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed. In contemporary practice, this must combine traditional electrophysiological techniques, such as activation and entrainment mapping, with more novel physiological mapping techniques for which there is an ever-increasing evidence base. Novel techniques to maximise energy delivery to the tissue must also be considered and balanced against their associated risks of complication. This review provides a comprehensive appraisal of contemporary practice and the evidence base that supports recent developments in mapping and ablation, while also considering potential future developments in the field.

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“…7 When intramural substrate was suspected, the lower ionic irrigant half-normal saline (HNS) was used instead of normal saline, in an attempt to deliver larger ablation lesions from the LV endocardial surface. [13][14][15] Alternatively, sequential unipolar ablation was performed from adjacent sides of either the ventricular septum or the endocardial and epicardial surfaces. When HNS was used, powers were titrated between 20 and 40 Watts, aiming for an impedance drop of 10-20 ohms.…”

Section: Ablationmentioning

confidence: 99%

“…In those patients whereby a standard approach to CA fails to control VT, several novel ablation strategies are available, including the use of HNS irrigation, [13][14][15] transcoronary ethanol ablation, 19,20 simultaneous unipolar ablation, 21 bipolar ablation, 22 SBRT, 16 needle catheter ablation, 17 and sympathectomy using either cardiac sympathetic denervation 23 or renal denervation. 24 Compared to standard CA, these novel strategies are supported by relatively small nonrandomized studies and are currently indicated for refractory cases.…”

Section: Va Recurrences Mortality and Cardiac Transplantationmentioning

confidence: 99%

Clinical, electroanatomic and electrophysiologic characterization and outcomes of catheter ablation for ventricular tachycardia following valvular intervention

Bennett

Garikapati

Anderson

et al. 2022

Cardiovasc electrophysiol

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Introduction: Ventricular tachycardia (VT) can occur following valvular interventions.There are limited data describing substrate and ablation approaches in such patients.We sought to describe the clinical, electrophysiologic, electroanatomic features and catheter ablation outcomes of patients with VT following aortic and/or mitral valve intervention.Methods: Over 12-years, consecutive patients with aortic valve replacement (AVR) and/ or mitral valve replacement (MVR) or repair, undergoing VT ablation, were identified from two centers. Clinical and procedural parameters and outcomes are described.Results: Twenty-three patients (age 66 ± 14years, 78% male, left ventricular ejection fraction 37 ± 16%), with prior AVR (mechanical n = 6, bioprosthetic n = 2, transcatheter n = 1), MVR (mechanical n = 5, bioprosthetic n = 1), mitral valve repair (n = 6) and both mechanical AVR and MVR (n = 2), underwent VT ablation. Sixteen had concurrent ischemic cardiomyopathy, 10 with prior bypass surgery. Left ventricular access was obtained in 21/23 (91%) patients (transseptal n = 14, retrograde aortic n = 5, transapical n = 2), with perivalvular scar identified in 17/21 (81%). Re-entrant VT isthmi involved the perivalvular regions in 12/23 (52%) patients, and regions remote from the valve in the remainder; 9% had nonscar-related VT. Intramural substrate was ablated from adjacent chambers in 5/23 (22%) patients and with halfnormal saline irrigation in 8/23 (35%) patients. There were no instances of catheter entrapment. Following final ablation, VA-free survival was 78% at 13-months.

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Catheter Ablation Using Half-Normal Saline and Dextrose Irrigation in an Ovine Ventricular Model

Cited by 26 publications

References 10 publications

Local impedance for the optimization of radiofrequency lesion delivery: A review of bench and clinical data

Local impedance for the optimization of radiofrequency lesion delivery: A review of bench and clinical data

Contemporary Management of Complex Ventricular Arrhythmias

Clinical, electroanatomic and electrophysiologic characterization and outcomes of catheter ablation for ventricular tachycardia following valvular intervention

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