室性心律失常（VA）的射频消融（RFA）的急性失败发生在10％-20％的患者中，部分原因是通过标准消融方案获得的病变深度不足。半生理盐水（HNS）冲洗是提高VA消融成功率的有希望的策略。
本研究调查了标准生理盐水溶液（PNSS）灌注消融失败后HNS灌注消融对特发性流出道室性心律失常（OT-VA）的疗效。
这是一项对接受特发性OT-VA射频消融的连续患者进行的前瞻性观察性研究，比较了额外的HNS灌注消融对失败的标准PNSS灌注消融的疗效。急性衰竭定义为自发性VA的持续性或临床VA的持续性诱导性。
在160例OT-VA病例中（51±15岁，62男性），31例标准PNSS灌注消融失败后接受HNS灌注。与PNSS组相比，HNS组的手术时间明显更长（60.06±43.83vs37.51±33.40分钟；P=.013）和更高的辐射暴露（31.45±20.24vs17.22±15.25分钟；P=.001），但在31例患者中有21例（67.7％）获得了额外的急性成功。随访7.8±4.6个月，确定了24次复发，其中HNS组8人（25.8%），PNSS组16人（12.4%），HNS组的复发自由度较低（对数秩P=.009）。未观察到重大并发症。
标准PNSS灌注消融失败后，HNS灌注消融是安全的，而且特发性OT-VA的急性消融成功率提高了67.7%，但随访时复发率更高。HNS作为初始冲洗剂的应用是否可以导致更好的结果需要进一步研究。
Acute failure of radiofrequency ablation (RFA) of ventricular arrhythmias (VAs) occur in 10%-20% of patients and is partly attributed to inadequate lesion depth acquired with standard ablation protocols. Half-normal saline (HNS)-irrigation is a promising strategy to improve the success rate of VA ablation.
This study investigated the efficacy of HNS-irrigated ablation after a failed standard plain normal saline solution (PNSS)-irrigated ablation on idiopathic outflow tract ventricular arrhythmia (OT-VA).
This is a prospective observational study of consecutive patients undergoing RFA of idiopathic OT-VA comparing the efficacy of additional HNS-irrigated ablation for failed standard PNSS-irrigated ablation. Acute failure was defined as persistence of spontaneous VA or persistent inducibility of the clinical VA.
Out of 160 OT-VA cases (51 ± 15-year-old, 62 males), 31 underwent HNS irrigation after a failed standard PNSS-irrigated ablation. The HNS group had a significantly longer procedure time (60.06 ± 43.83 vs 37.51 ± 33.40 minutes; P = .013) and higher radiation exposure (31.45 ± 20.24 vs 17.22 ± 15.25 minutes; P = .001) than the PNSS group but provided an additional acute success in 21 of 31 (67.7%) patients. Over a follow-up duration of 7.8 ± 4.6 months, 24 recurrences were identified, including 8 (25.8%) in the HNS and 16 (12.4%) in the PNSS group, with lower freedom from recurrence in the HNS group (log rank P = .009). No major complication was observed.
HNS-irrigated ablation after failed standard PNSS-irrigated ablation is safe and additionally improves acute ablation success by 67.7% for idiopathic OT-VA but with a higher rate of recurrence on follow-up. Whether the application of HNS as initial irrigant could result in better outcome requires further investigation.
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