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Experience With End-Hole Irrigated Needle Catheter for Ablation
Quick Takes
- In this study of 111 patients with refractory ventricular arrhythmias, irrigated needle ablation eliminated targeted PVCs in 89% of patients, and in patients with VT, 47% had improvement or abolition of the arrhythmia at 6 months of follow-up.
- Adverse events with irrigated needle ablation were infrequent and included pericardial effusions (3.5%), AV block (2.6%), and heart failure exacerbations (2.6%). There were no procedure-related deaths.
Study Questions:
What are the outcomes and complications in patients undergoing ventricular arrhythmia ablation with a retractable 27-G end-hole needle catheter?
Methods:
The authors reported outcomes and complications from patients at four international ablation centers who underwent irrigated needle ablation for ventricular tachycardia (VT) or high-density premature ventricular contractions (PVCs).
Results:
Irrigated needle ablation was performed in 111 patients. It acutely abolished targeted PVCs in 33 of 37 patients (89%), and PVCs were reduced to <5,000/day in 29 patients (78%). During 6-month follow-up, freedom from hospitalization was observed in 69% of patients, and improvement or abolition of VT occurred in 47%. After irrigated needle ablation, additional endocardial standard radiofrequency ablation was required in 23% of patients. Adverse events included four pericardial effusions (3.5%), three cases of (anticipated) atrioventricular (AV) block (2.6%), and three heart failure exacerbations (2.6%). During 6-month follow-up, five deaths occurred; none were procedure-related.
Conclusions:
The authors conclude that irrigated needle ablation improved arrhythmia control in 78% of patients with PVCs and prevented hospitalization in 69% of patients with VT refractory to standard ablation at 6-month follow-up. Procedural risks are acceptable.
Perspective:
Deep intramural substrate is the cause of failure in the majority of ablations for ventricular arrhythmia. Irrigated needle ablation with a retractable 27-G end-hole needle catheter allows intramural mapping and ablation from an endocardial approach. In this paper, the authors report outcomes and complications of the entire population treated with this experimental second-generation needle catheter. The newest catheter has a slightly larger needle with multiple pores along the shaft and injects heated saline into the tissue that creates substantially larger ablation lesions than those with the prior device. Procedural outcomes were favorable and the complication risks were comparable to standard ablation procedures, suggesting that the irrigated needle ablation should be further evaluated in future clinical studies.
Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Pericardial Disease, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Arrhythmias, Cardiac, Atrioventricular Block, Catheter Ablation, Electrophysiology, Heart Failure, Pericardial Effusion, Radiofrequency Ablation, Secondary Prevention, Tachycardia, Ventricular, Ventricular Premature Complexes
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