CA-531-04 CANADIAN EXPERIENCE WITH SALINE ENHANCED RADIOFREQUENCY NEEDLE TIP ABLATION FOR VENTRICULAR TACHYCARDIA (SERF VT CANADA TRIAL)

Abstract

Endocardial catheter ablation for ventricular tachycardia (VT) may fail because of the inability to deliver transmural lesions. Saline-enhanced radiofrequency (SERF) ablation uses a needle tip catheter which is placed at varying depths into the myocardial tissue and heated saline is injected along with radiofrequency (RF) creating fully transmural lesions. We report the first in-human SERF ablation for VT in Canada. The purpose of this study is to describe the prospective outcomes on a seriesof patients undergoing first-in-human SERF ablation for VT in Canada under an Investigational Testing Authorization. Twenty-five patients with ischemic and non-ischemic cardiomyopathy, with recurrent monomorphic drug-refractory VT which had failed a prior catheter ablation underwent SERF ablation in 3 different centers in Canada. After a voltage map, the mapping catheter was replaced with the needle-tipped ablation catheter, which was located perpendicular to the myocardium and extended either 6 or 8 mm into the tissue. Sterile saline solution was infused with a flow rate of 10 ml/min and 60° C and 50 watts of RF was used. LVEF was 33.3% ± 8.6, mean age was 69.5 ± 6.4 years; 92% were male. From 43 clinical VT induced, 42 were attempted and 266 SERF lesions were delivered (10.6 ± 4.9 per patient). At the end of the case, 41 VT were non-inducible (98%) and 24 patients (96%) had their VT eliminated. At 6 months follow-up, VT burden was reduced by 87%. Complications included 2 strokes, 2 pericardial effusion and one patient had ischemic bowel and 1died. SERF ablation is feasible and permits control of symptomatic monomorphic VT in drug-refractory patients with a prior failed ablation.