Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Sep-Oct;23(5):163-165.
doi: 10.1016/j.ipej.2023.06.003. Epub 2023 Jun 17.

External irrigation of a non-irrigated ablation catheter for effective AV node ablation during conduction system pacing

Ankit Mahajan  1 , Calambur Narasimhan  2 , Pugazhendhi Vijayaraman  3
Affiliations
Case Reports

External irrigation of a non-irrigated ablation catheter for effective AV node ablation during conduction system pacing

Ankit Mahajan et al. Indian Pacing Electrophysiol J. 2023 Sep-Oct.

Erratum in

Abstract

Ablation using non-irrigated catheter can lead to rapid rise in temperature of electrode tissue interface from tissue desiccation, steam and coagulum formation and this may limit power delivery and lesion size. We present a novel technique of external irrigation through the long sheath while using a non-irrigated ablation catheter during AV Node ablation and conduction system pacing. By bringing the long sheath closer to the tip of non-irrigated catheter and injecting cold normal saline allows cooling of electrode tissue interface leading to increase in power delivery resulting in a deeper lesion.

Keywords: AV node ablation; Conduction system pacing; External irrigation; Non-irrigated catheter.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Pugazhendhi Vijayaraman reports a relationship with Medtronic that includes: consulting or advisory, funding grants, speaking and lecture fees, and travel reimbursement. Pugazhendhi Vijayaraman reports a relationship with Boston Scientific Corp that includes: speaking and lecture fees. Pugazhendhi Vijayaraman reports a relationship with Abbott that includes: consulting or advisory. Pugazhendhi Vijayaraman reports a relationship with BIOTRONIK Inc that includes: speaking and lecture fees. Pugazhendhi Vijayaraman has patent HBP delivery catheter issued to Pugazhendhi Vijayaraman.

Figures

Fig. 1
Fig. 1
A. Baseline ECG and electrogram from the pacing lead demonstrate, left bundle branch (LBB) potential to V interval of 20 ms and nonselective LBB pacing demonstrate short stimulus to R-wave peak time of 71 ms in lead V6. B. Fluoroscopic view of the deflectable sheath advanced close to the ablation catheter tip for effective external irrigation.
Fig. 2
Fig. 2
A. The side port of the deflectable sheath was connected to two 60 cc syringes via a 3-way stopcock and normal saline was rapidly infused. B. Ablation at the AV nodal region resulted in rapid rise of catheter tip temperature to 65 °C within a few seconds limiting the power to <20 W. External irrigation (single arrow) resulted in increase of power delivery to 40 Watts and a corresponding 20 Ohm impedance drop. When the first 60 cc infusion was completed, the power decreased to 17 Watts requiring a second injection (double arrow) to increase the power delivery.
See this image and copyright information in PMC

References

    1. Brignole M., Pentimalli F., Palmisano P., et al. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021;42(46):4731–4739. doi: 10.1093/eurheartj/ehab569. [published Online First: Epub Date]|. - DOI - PubMed
    1. Ganesan A.N., Brooks A.G., Roberts-Thomson K.C., Lau D.H., Kalman J.M., Sanders P. Role of AV nodal ablation in cardiac resynchronization in patients with coexistent atrial fibrillation and heart failure: a systematic review. J Am Coll Cardiol. 2012;59(8):719–726. doi: 10.1016/j.jacc.2011.10.891. [published Online First: Epub Date]|. - DOI - PubMed
    1. Corrigendum to: 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2022;43(17) doi: 10.1093/eurheartj/ehac075. 1651-51. [published Online First: Epub Date]|. - DOI - PubMed
    1. Vijayaraman P., Mathew A.J., Naperkowski A., et al. Conduction system pacing versus conventional pacing in patients undergoing atrioventricular node ablation: nonrandomized, on-treatment comparison. Heart Rhythm O2. 2022;3(4):368–376. doi: 10.1016/j.hroo.2022.04.005. [published Online First: Epub Date]|. - DOI - PMC - PubMed
    1. Chatterjee N.A., Upadhyay G.A., Ellenbogen K.A., McAlister F.A., Choudhry N.K., Singh J.P. Atrioventricular nodal ablation in atrial fibrillation. Circulation: Arrhythmia and Electrophysiology. 2012;5(1):68–76. doi: 10.1161/CIRCEP.111.967810. [published Online First: Epub Date]|. - DOI - PubMed

Publication types