Injection of cold saline for diagnosis of intramural ventricular arrhythmias

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Miki YokokawaFrank Bogun

Abstract

The failure to identify a successful target site for catheter ablation despite extensive endocardial and epicardial mapping is a common feature for an intramural site of origin of a ventricular arrhythmia. The purpose of this study was to assess whether transient suppression of premature ventricular complexes (PVCs) by injection of cold saline into the distal coronary venous system can identify an intramural focus. Cold saline (room temperature) was injected through an irrigated-tip catheter into the distal coronary venous system in a consecutive series of 26 patients with frequent PVCs referred for catheter ablation. PVCs were temporarily suppressed in 11 of 26 patients during injection of cold saline. Extensive mapping suggested the presence of an intramural site of origin in 9 of 11 patients with PVC suppression by cold saline but in only 1 of 15 patients in whom PVCs were not suppressed. The suppression of PVCs by cold saline was associated with the presence of an intramural PVC focus with an accuracy of 88% (sensitivity 90%, specificity 88%, positive predictive value 82%, negative predictive value 93%, P = .0002). Temporary suppression of PVCs by cold saline infused into the distal coronary venous system and the perforator...Continue Reading

References

Mar 13, 2012·Circulation. Arrhythmia and Electrophysiology·Miki YokokawaFrank Bogun

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Citations

Jun 27, 2017·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Seth H SheldonFrank Bogun
Sep 15, 2016·Circulation. Arrhythmia and Electrophysiology·Pasquale Santangeli, David J Callans
May 11, 2019·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Edmond M CroninUNKNOWN ESC Scientific Document Group
Dec 4, 2019·Clinical Case Reports·Kaoru OkishigeKenzo Hirao
Jan 28, 2020·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Edmond M CroninKatja Zeppenfeld
Oct 31, 2020·JACC. Clinical Electrophysiology·Michael GhannamFrank Bogun
Jun 10, 2021·Methodist DeBakey Cardiovascular Journal·Jackson J Liang, Frank Bogun

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