The effect of half-normal saline irrigation on lesion characteristics in temperature-flow-controlled ablation

Ikenouchi, Takashi; Takigawa, Masateru; Goya, Masahiko; Yamaguchi, Junji; Martin, Claire A.; Yamamoto, Tasuku; Negishi, Miho; Kawamura, Iwanari; Goto, Kentaro; Shigeta, Takatoshi; Nishimura, Takuro; Takamiya, Tomomasa; Tao, Susumu; Miyazaki, Shinsuke; Sasano, Tetsuo

doi:10.1007/s10840-023-01678-7

Cited by 2 publications

(1 citation statement)

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“…As demonstrated in previous clinical studies, 9 , 10 , 21 , 28 the safety and efficacy of HNS irrigation may vary depending on the catheter platform, including factors such as electrode size and material, location and the number of thermocouples, volume, and method of irrigation, and the ablation mode (e.g., power‐controlled vs. temperature control). It is conceivable that the use of HNS‐irrigation may be safer and more effective than increasing the power of duration with one catheter platform, while the opposite may be true for another catheter platform.…”

Section: Discussionmentioning

confidence: 92%

An optimized approach for increasing lesion size in temperature‐controled setting using a catheter with a surface thermocouple and efficient irrigation

Takigawa,

Yamaguchi,

Goya

et al. 2024

Journal of Arrhythmia

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BackgroundWe explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature‐control setting.MethodsWe conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS‐irrigation) and Half NS‐irrigation (HNS‐irrigation) in an ex‐vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS‐irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS‐irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.ResultsIn Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS‐irrigation and 34 in HNS‐irrigation (p = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS‐irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. The optimal %impedance‐drop cutoff to predict steam pops was 20% with a negative‐predictive‐value (NPV) = 95.1% including NS‐ and HNS‐irrigation groups, and 22% with an NPV = 96.1% in NS‐irrigation group. In Step 2, similar to the ex‐vivo model, lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. Steam pops were absent with NS‐irrigation (0/35) even with the largest %impedance‐drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS‐irrigation (6/21, 29%). The optimal %impedance‐drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS‐ and HNS‐irrigation groups.ConclusionsRather than using HNS‐irrigation, very long‐duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS‐irrigation.

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