Abstract 12331: Prospective Evaluation of Risks Ventricular Arrhythmia Ablation With Half Normal Saline Irrigation

Abstract

Background: Failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VA) is often due to inadequate lesion size. RFA with half-normal saline (HNS) irrigation has the potential to increase lesion size, but can increase steam pops, which could increase risks of perforation and emboli. Optimal energy titration is not defined. Objective: To assess peri-procedural complications of ventricular arrhythmia (VA) ablation with HNS RFA guided by impedance monitoring and intracardiac ultrasound (ICE). Methods: All patients undergoing endocardial RFA only for VA from October 2018 to September 2021 were prospectively assessed for complications in hospital and at 30 days by clinic visit or phone call. Of 862 procedures 616 patients undergoing 663 endocardial RFA were included. HNS or normal saline (NS) RF irrigation and were selected at the discretion of the physician. RFA power was titrated to a < 15 Ohm impedance fall with intracardiac ultrasound monitoring for tissue whitening and increasing bubble formation in most cases. Results: Of 663 procedures HNS was used in 552 (83%) and NS in 111 (17%). The HNS group was older, with more heart disease, ventricular tachycardia, LV ablation sites, and RFA time. There were 59 complications (8.9%) in 53 procedures, including 11 pericardial effusions (1.6%) (2 requiring surgical repair), and 2 strokes (0.3%). There was no significant difference between HNS and HS in complications or mortality (table). Conclusion: HNS irrigation ablation with power guided by impedance fall and ICE is associated with a low incidence of serious complications. A small difference can not be excluded, but would require a very large trial and seems unlikely to be clinically relevant.