TY - JOUR
T1 - Half-normal saline versus normal saline for irrigation of open-irrigated radiofrequency catheters in atrial fibrillation ablation
AU - Gianni, Carola
AU - Gallinghouse, G. Joseph
AU - Al-Ahmad, Amin
AU - Horton, Rodney P.
AU - Bailey, Shane M.
AU - Burkhardt, J. David
AU - Bassiouny, Mohamed A.
AU - MacDonald, Bryan C.
AU - Quintero Mayedo, Angel
AU - Della Rocca, Domenico G.
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Di Biase, Luigi
AU - Hranitzky, Patrick M.
AU - Sanchez, Javier E.
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/4
Y1 - 2021/4
N2 - Background: The creation of effective and permanent lesions is a crucial factor in determining the success rate of atrial fibrillation (AF) ablation. By increasing the efficacy of radiofrequency (RF) energy-mediated lesion formation, half-normal saline (HNS) as an irrigant for open-irrigated ablation catheters has the potential to reduce procedural times and improve acute and long-term outcomes. Methods: This is a double-blind randomized clinical trial of 99 patients undergoing first-time RF catheter ablation for AF. Patients enrolled were randomly assigned in a 1:1 fashion to perform ablation using HNS or normal saline (NS) as an irrigant for the ablation catheter. Results: The use of HNS is associated with shorter RF times (26 vs. 33 min; p =.02) with comparable procedure times (104 vs. 104 min). The rate of acute pulmonary vein reconnections (16% vs. 18%) was comparable, with a median of 1 vein reconnection in the HNS arm versus 2 in the NS arm. There was no difference in procedure-related complications, including the incidence of postprocedural hyponatremia when using HNS. Over the 1-year follow-up, there is no significant difference between the HNS and NS with respect to the recurrence of any atrial arrhythmia (off antiarrhythmic drugs [AAD]: 47% vs. 52%; hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 0.66–2.06; off/on AAD: 66% vs. 66%, HR: 1.06, 95% CI: 0.53–2.12), with a potential benefit of using HNS when considering the paroxysmal AF cohort (on/off AAD 73% vs. 62%, HR: 0.72, 95% CI: 0.19–2.70). Conclusions: In a mixed cohort of patients undergoing first-time AF ablation, irrigation of open-irrigated RF ablation catheters with HNS is associated with shorter RF times, with a comparably low rate of procedure-related complications. In the long term, there is no significant difference with respect to the recurrence of any atrial arrhythmia. Larger studies with a more homogeneous population are necessary to determine whether HNS improves clinical outcomes.
AB - Background: The creation of effective and permanent lesions is a crucial factor in determining the success rate of atrial fibrillation (AF) ablation. By increasing the efficacy of radiofrequency (RF) energy-mediated lesion formation, half-normal saline (HNS) as an irrigant for open-irrigated ablation catheters has the potential to reduce procedural times and improve acute and long-term outcomes. Methods: This is a double-blind randomized clinical trial of 99 patients undergoing first-time RF catheter ablation for AF. Patients enrolled were randomly assigned in a 1:1 fashion to perform ablation using HNS or normal saline (NS) as an irrigant for the ablation catheter. Results: The use of HNS is associated with shorter RF times (26 vs. 33 min; p =.02) with comparable procedure times (104 vs. 104 min). The rate of acute pulmonary vein reconnections (16% vs. 18%) was comparable, with a median of 1 vein reconnection in the HNS arm versus 2 in the NS arm. There was no difference in procedure-related complications, including the incidence of postprocedural hyponatremia when using HNS. Over the 1-year follow-up, there is no significant difference between the HNS and NS with respect to the recurrence of any atrial arrhythmia (off antiarrhythmic drugs [AAD]: 47% vs. 52%; hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 0.66–2.06; off/on AAD: 66% vs. 66%, HR: 1.06, 95% CI: 0.53–2.12), with a potential benefit of using HNS when considering the paroxysmal AF cohort (on/off AAD 73% vs. 62%, HR: 0.72, 95% CI: 0.19–2.70). Conclusions: In a mixed cohort of patients undergoing first-time AF ablation, irrigation of open-irrigated RF ablation catheters with HNS is associated with shorter RF times, with a comparably low rate of procedure-related complications. In the long term, there is no significant difference with respect to the recurrence of any atrial arrhythmia. Larger studies with a more homogeneous population are necessary to determine whether HNS improves clinical outcomes.
KW - atrial fibrillation ablation
KW - half-normal saline
KW - irrigated tip ablation catheter
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U2 - 10.1111/jce.14885
DO - 10.1111/jce.14885
M3 - Article
C2 - 33442937
AN - SCOPUS:85101460289
SN - 1045-3873
VL - 32
SP - 973
EP - 981
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 4
ER -