Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-AB09 - Advances in Radiofrequency Ablation Lesion Science: Optimizing Settings and Outcomes (ID 46) Abstract

D-AB09-04 - High-power Short-duration Radiofrequency Ablation Using Half-normal Saline For Irrigation In Patients With Atrial Fibrillation (ID 755)

  A. Maan: Research (Contracted Grants for PIs and Named Investigators only) - Medtronic Japan; Biosense Webster, Inc.; Biotronik.


Background: Although the use of high-power short-duration (HPSD) has been described for ablation of Atrial Fibrillation (AF), the data regarding combining with half-normal saline remain limited.
Objective: In this study, we investigated the safety and efficacy of using HPSD in combination of half-normal saline with various other strategies and its impact on long term freedom from AF.
Methods: A total of 100 consecutive patients underwent RFA using a strategy of HPSD, half-normal saline for catheter irrigation, 1 mm tags for the electro-anatomical mapping system (Carto), high frequency jet ventilation (HFJV), contact force range of 5-20 grams, unipolar pacing after ablation to verify areas of non-capture, atrial/ventricular pacing at 500-700 msec during RFA to aid in catheter stability, 2 indifferent skin electrode to reduce impedance, and Adenosine infusion to verify isolation of PVs after ablation. Power modulation was manually guided by impedance changes. Patients were given 30-day monitor at 3, 6, and 12 months after the procedure.
Results: The average age of patients was 65.2 years and 70% were males, 47% had paroxysmal AF and the median CHA2DS2-Vasc score was 3. The mean procedural time in our study was 192.2 + 55.2 minutes. The average power used was 38.1 + 3.3 W and the contact force 11.6 + 1.7 grams. Median number of ablation lesions applied per procedure was 392 + 50. The average net fluid balance for a given ablation procedure was 922 + 661 ml. Upon a median follow up of 304 + 156 days, 89% of the patients remained free from any atrial arrhythmias after a single RFA procedure. There was no death, stroke, pericardial effusion, or atrio-esophageal fistula.
Conclusion: HPSD in combination with half-normal saline and HFJV is safe and is associated with high rate of freedom from AF.