Clinical efficacy of open‐irrigated electrode cooled with half‐normal saline for initially failed radiofrequency ablation of idiopathic outflow tract ventricular arrhythmias

Chung, Fa Po; Lin, Yenn Jiang; Lo, Li Wei; Hu, Yu Feng; Tuan, Ta Chuan; Chao, Tze Fan; Liao, Jo Nan; Chang, Tsan‐Kuo; Salim, Simon; Liu, Chih Min; Chuang, Chieh Mao; Chen, Chun Chao; Chin, Chye Gen; Wu, Chen-Tu; Chou, Ching Yao; Chen, Shih Ann

doi:10.1111/jce.14057

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…18 In patients with failed RFA using normal saline irrigation for outflow tract PVCs, the use of half-normal saline yielded acute success in 68% without an increase in complications. 19 However, during follow-up, the rate of recurrence was much higher in the half-normal saline group compared to the normal saline group (26% versus 12%). Therefore, RFA using half-normal saline for outflow tract PVCs is of unclear benefit.…”

Section: Discussionmentioning

confidence: 84%

Intramural Needle Ablation for Refractory Premature Ventricular Contractions

Dukkipati

Nakamura

Nakajima

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Frequent premature ventricular contractions (PVCs) are often amenable to catheter ablation. However, a deep intramural focus may lead to failure due to inability of standard ablation techniques to penetrate the focus. We sought to assess the efficacy and safety of infusion needle ablation (INA) for PVCs that are refractory to standard radiofrequency ablation. Methods: Under 2 Food and Drug Administration approved protocols, INA was evaluated in patients with frequent PVCs that were refractory to standard ablation. Initial targets for ablation were selected by standard mapping techniques. INA was performed with a deflectable catheter equipped with an extendable/retractable needle at the tip that can be extended up to 12 mm into the myocardium and is capable of pacing and recording. After contrast injection for location assessment, radiofrequency ablation was performed with the needle tip using a temperature-controlled mode (maximum temperature 60 °C) with saline infusion from the needle. The primary end point was a decrease in PVC burden to <5000/24 hours at 6 months. The primary safety end point was incidence of procedure- or device-related serious adverse events. Results: At 4 centers, 35 patients (age 55.3±16.9 years, 74.2% male) underwent INA. The baseline median PVC burden was 25.4% (interquartile range, 18.4%–33.9%) and mean left ventricular ejection fraction was 37.7±12.3%. Delivering 10.3±8.0 INA lesions/patient (91% had adjunctive standard radiofrequency ablation also) resulted in acute PVC elimination in 71.4%. After a mean follow-up of 156±109 days, the primary efficacy end point was met in 73.3%. The median PVC burden decreased to 0.8% (interquartile range, 0.1%–6.0%; P <0.001). The primary safety end point occurred in 14.3% consisting of 1 (2.9%) heart block, 1 (2.9%) femoral artery dissection, and 3 (8.6%) pericardial effusions (all treated percutaneously). Conclusions: INA is effective for the elimination of frequent PVCs that are refractory to conventional ablation and is associated with an acceptable safety profile. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01791543 and NCT03204981.

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Section: Discussionmentioning

confidence: 84%

Intramural Needle Ablation for Refractory Premature Ventricular Contractions

Dukkipati

Nakamura

Nakajima

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…Successful ablation was defined as the absence of any spontaneous and inducible ventricular arrhythmia (VA) at the end of the procedure, with and/or without isoproterenol 22,28 . Partial success was defined as inducible nonclinical VAs after ablation, while failed ablation was defined as inducible clinical VAs.…”

Section: Methodsmentioning

confidence: 99%

“…27 Successful ablation was defined as the absence of any spontaneous and inducible ventricular arrhythmia (VA) at the end of the procedure, with and/or without isoproterenol. 22,28 Partial F I G U R E 1 An example of window setting of conventional mapping and mapping by LiveView Dynamic Display. A patient with arrhythmogenic right ventricular dysplasia with ventricular tachycardia.…”

Section: Ablation Strategy and Outcome Definitionmentioning

confidence: 99%

Application of Ensite™ LiveView function for identification of scar‐related ventricular tachycardia isthmus

Kao

Chung

Lin

et al. 2022

Cardiovasc electrophysiol

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Introduction Dynamic display of real‐time wavefront activation pattern may facilitate the recognition of reentrant circuits, particularly the diastolic path of ventricular tachycardia (VT). Objective We aimed to evaluate the feasibility of LiveView Dynamic Display for mapping the critical isthmus of scar‐related reentrant VT. Methods Patients with mappable scar‐related reentrant VT were selected. The characteristics of the underlying substrates and VT circuits were assessed using HD grid multielectrode catheter. The VT isthmuses were identified based on the activation map, entrainment, and ablation results. The accuracy of the LiveView findings in detecting potential VT isthmus was assessed. Results We studied 18 scar‐related reentrant VTs in 10 patients (median age: 59.5 years, 100% male) including 6 and 4 patients with ischemic and nonischemic cardiomyopathy, respectively. The median VT cycle length was 426 ms (interquartile range: 386–466 ms). Among 590 regional mapping displays, 92.0% of the VT isthmus sites were identified by LiveView Dynamic Display. The accuracy of LiveView for isthmus identification was 84%, with positive and negative predictive values of 54.8% and 97.8%, respectively. The area with abnormal electrograms was negatively correlated with the accuracy of LiveView Dynamic Display (r = −.506, p = .027). The median time interval to identify a VT isthmus using LiveView was significantly shorter than that using conventional activation maps (50.5 [29.8–120] vs. 219 [157.5–400.8] s, p = .015). Conclusion This study demonstrated the feasibility of LiveView Dynamic Display in identifying the critical isthmus of scar‐related VT with modest accuracy.

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“…This will result in increased lesion size and, considering the data of the current study, a higher incidence of steam pops. 7…”

Section: What Happens During Rf Lesion Creation?mentioning

confidence: 99%