Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.
Department of Cardiology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.
JACC Clin Electrophysiol. 2021 Oct;7(10):1229-1239. doi: 10.1016/j.jacep.2021.05.002. Epub 2021 Jun 30.
This study hypothesized that catheter ablation in healthy ovine ventricular myocardium using low ionic 0.45% saline (half-normal saline [HNS]) and nonionic 5% dextrose in water (D5W) would result in larger lesions compared with use of 0.9% saline (normal saline [NS]).
Limited data exist regarding the safety and efficacy of catheter ablation using low and nonionic irrigants.
Open irrigated ablation was performed on 14 beating ovine hearts (NS, n = 5; HNS, n = 4; D5W, n = 5). Ablation was delivered by using identical parameters (ie, 30 W in power control mode, 60-second duration, contact force of 10-20 g in the endocardial ventricles and 5-10 g in the epicardium). Catheter orientation and tissue contact were optimized by using intracardiac echocardiography. Lesion width, depth, and volume and number of steam pops were compared.
Overall, 196 lesions were analyzed (mean duration: 56.7 ± 8.3 seconds; mean contact force: 15.3 ± 6.1 g; and mean impedance drop: 31 ± 19.1 Ω). Compared with NS, HNS and D5W resulted in larger lesion volumes (NS 349.2 ± 245.1 mm vs HNS 645.7 ± 386.4 mm vs D5W 633.2 ± 387.1 mm; HNS vs NS; P < 0.001; D5W vs NS; P < 0.001; D5W vs HNS; P = 0.87). However, D5W was associated with higher steam pop occurrence (NS 5% vs HNS 11% vs D5W 35%; HNS vs NS; P = 0.22; D5W vs NS; P < 0.001; D5W vs HNS; P = 0.002).
Catheter ablation with HNS and D5W resulted in larger ablation lesions compared with NS but similar lesion dimensions between HNS and D5W. The increase in lesion size with HNS and D5W was associated with a higher incidence of steam pops, especially with D5W, compared with NS.
本研究假设，在健康的绵羊心室心肌中使用低离子 0.45%盐水（半生理盐水[HNS]）和非离子 5%葡萄糖水（D5W）进行导管消融，与使用 0.9%盐水（生理盐水[NS]）相比，会导致更大的消融灶。
关于使用低离子和非离子灌流液进行导管消融的安全性和有效性的数据有限。
在 14 只跳动的绵羊心脏上进行开放的灌流消融（NS 组，n=5；HNS 组，n=4；D5W 组，n=5）。使用相同的参数进行消融（即在功率控制模式下 30 W，持续 60 秒，心内膜心室的接触力为 10-20 g，心外膜的接触力为 5-10 g）。通过心内超声心动图优化导管方向和组织接触。比较消融灶的宽度、深度、体积和蒸汽爆破的数量。
总共分析了 196 个消融灶（平均持续时间：56.7±8.3 秒；平均接触力：15.3±6.1 g；平均阻抗下降：31±19.1 Ω）。与 NS 相比，HNS 和 D5W 导致更大的消融灶体积（NS 349.2±245.1 mm 比 HNS 645.7±386.4 mm 比 D5W 633.2±387.1 mm；HNS 比 NS；P<0.001；D5W 比 NS；P<0.001；D5W 比 HNS；P=0.87）。然而，D5W 与更高的蒸汽爆破发生率相关（NS 5%比 HNS 11%比 D5W 35%；HNS 比 NS；P=0.22；D5W 比 NS；P<0.001；D5W 比 HNS；P=0.002）。
与 NS 相比，使用 HNS 和 D5W 进行导管消融会导致更大的消融灶，但 HNS 和 D5W 之间的消融灶尺寸相似。与 NS 相比，HNS 和 D5W 导致的消融灶增大与蒸汽爆破发生率的增加相关，尤其是 D5W。
