Systematic use of half normal saline during ablation of ventricular tachycardia in structural heart disease.

Abstract

Efficiency and safety of ablation using half normal saline (HNS) has been shown in refractory ventricular tachycardia (VT), but no evaluation in unselected larger populations has been made. To evaluate the efficiency and safety of systematic HNS ablation in VT ablation. All successive VT ablations in patients with structural heart disease from 2018 to 2021 used HNS in our center and were retrospectively included. One hundred seventy-seven successive VT ablation procedures using HNS have been performed in 148 patients (91% males, mean 64±12 years, ischemic cardiomyopathy 64%, left ventricular ejection fraction 38±13%). A mean of 19±7.5 min of RF was delivered, with a mean power of 44±7W. Relevant complications happened in 9% (strokes 2%, tamponades 3%, atrioventricular block during septal ablations 5%). Over a mean follow-up of 15±9 months, VT recurred in 46%. Final recurrence rate after one or several procedures was 36% (18 months follow-up). Number of VT episodes decreased from 14±35 before to 2.5±10 after ablation (p<.0001) and number of ICD shocks decreased from 4.8±6.8 to 1.5±0.8 (p=.027). Systematic use of HNS during VT ablations in patients with structural heart disease leads to long-term recurrences rates and complications in the range of what is reported using normal saline. Although controlled studies are needed for demonstrating the superiority of such attitude, the use of HNS in every scar-related VT ablation seems safe for standard cases and may be furthermore useful in case of refractory arrhythmias due to difficult-to-ablate substrates.