Irrigated needle ablation (INA) with a retractable end-hole needle catheter can help improve arrhythmia control and avoid hospitalization for patients with treatment refractory ventricular arrhythmia due to a nonendocardial ventricular arrhythmia substrate, according to a late-breaking clinical trial presented during Heart Rhythm 2023 and simultaneously published May 19 in JACC: Clinical Electrophysiology.

Usha B. Tedrow, MD, et al., previously reported the feasibility of INA with a retractable 27G end-hole needle catheter to target the nonendocardial substrate. In the present analysis, they reported the six-month outcomes with INA in all 111 patients with either recurrent sustained monomorphic ventricular tachycardia (VT) or high-density premature ventricular contractions (PVC) enrolled at four centers. The median age of the patients was 64 years, 84% were men and 71% had nonischemic cardiomyopathy. Before ablation, amiodarone therapy had failed in 68%.

Results showed that INA abolished targeted PVCs in 33 of 37 patients (89%) and the primary endpoint at six months of a reduction in PVCs to <5,000/day was achieved in 29 patients (78%). Among the 72 patients who had INA for VT, the primary endpoint of control of VT defined by freedom from hospitalization for recurrent VT was achieved in 50 patients (69%). 

Multiple applications of INA were required in all patients, with more in the VT group than the PVC group (mean of 12 vs. 7; p<0.01). Additional endocardial standard radiofrequency ablation was needed in 23% of patients post INA.

During the six-month follow-up, there were four cases (3.5%) of pericardial effusions, three cases (2.6%) of (anticipated) atrioventricular block as well as three heart failure exacerbations (2.6%). Five deaths occurred although none were related to INA.

In reporting what they say is the entire worldwide experience with INA, the authors conclude that based on the six-month data INA achieves improved arrhythmia control in 78% of patients with PVCs and avoids hospitalization in 69% of patients with VT refractory to standard ablation.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Pericardial Disease, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Electrophysiology, Cardiomyopathies, Radiofrequency Ablation, Tachycardia, Ventricular, Ventricular Premature Complexes, Pericardial Effusion, Polyvinyl Chloride, Atrioventricular Block, Amiodarone

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