Background Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated radiofrequency ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrgant were used for NS and HNS, but could increase risks related to steam pops and lesion size. Aims To assess peri-procedural complications and acute ablation outcome of ventricular arrhythmias ablation with HNS. Methods Prospective assessment of outcomes was performed in 1,024 endocardial and/or epicardial radiofrequency ablation procedures in 935 consecutive patients (median age 64 years, 71.2% men, 73.4% cardiomyopathy, 47.2% sustained ventricular tachycardia). HNS was selected at the discretion of the treating physician. RF ablation power was generally titrated to a ≤ 15 Ohm impedance fall with intracardiac echocardiography monitoring. Results HNS was used in 900 (87.9%) and normal saline in 124 (12.1%) procedures. Any adverse event within 30 days occurred in 13.0% of patients treated with HNS RF ablation including 4 (0.4%) strokes/transient ischemic attacks and 34 (3.8%) pericardial effusions requiring treatment (most related to epicardial access). Two steam pops with perforation required surgical repair (0.2%). Patients who received normal saline irrigation had less severe disease and arrhythmias. In multivariable models, adverse events, and acute success of the procedure were not related to the type of irrigation. Conclusion HNS irrigation RF ablation with power guided by impedance fall and intracardiac echocardiography has an acceptable rate of complications and acute ablation success while administering half of the saline load expected for normal saline irrigation.

中文翻译：

---

半生理盐水冲洗室性心律失常射频消融的安全性

背景 室性心律失常的射频（RF）消融失败通常是由于病灶尺寸不足造成的。如果对 NS 和 HNS 使用相同体积的射频冲洗剂，则使用半生理盐水 (HNS) 进行冲洗射频消融可能会增加病灶大小并减少向患者输送的钠，但可能会增加与蒸汽爆裂和病灶大小相关的风险。目的 评估 HNS 室性心律失常消融的围手术期并发症和急性消融结果。方法 对 935 名连续患者（中位年龄 64 岁，71.2% 男性，73.4% 心肌病，47.2% 持续性室性心动过速）的 1,024 例心内膜和/或心外膜射频消融手术的结果进行前瞻性评估。HNS 的选择由治疗医生酌情决定。通常通过心内超声心动图监测将射频消融功率滴定至 ≤ 15 欧姆阻抗下降。结果 900 例（87.9%）手术中使用了 HNS，124 例（12.1%）手术中使用了生理盐水。13.0% 的 HNS 射频消融治疗患者在 30 天内发生任何不良事件，包括 4 例 (0.4%) 中风/短暂性脑缺血发作和 34 例 (3.8%) 需要治疗的心包积液（大多数与心外膜通路相关）。两个穿孔的蒸汽爆破需要手术修复（0.2%）。接受生理盐水冲洗的患者病情和心律失常的严重程度较轻。在多变量模型中，不良事件和手术的急性成功与冲洗类型无关。结论 采用阻抗下降和心内超声心动图引导功率的 HNS 冲洗射频消融具有可接受的并发症发生率和急性消融成功率，同时施用生理盐水冲洗预期盐水负荷的一半。