Arrhythmias & electrophysiology
Can Intracardiac Echocardiography Reduce Steam Pops During Half-Normal Saline Irrigated Radiofrequency Ablation?
Authors' conclusion
Steam pops occurred in 2% of half-normal saline radiofrequency applications titrated to an impedance fall and are likely under-recognized without ICE. On ICE, steam pops are usually preceded by tissue whitening or a sudden increase in bubble formation, which can potentially be used to adjust radiofrequency application to help reduce pops.
Study context
- Population
- Patients undergoing endocardial ventricular arrhythmia RF ablation with half-normal saline irrigationablation applications in 100 patients
- Participants
- 2,190 ablation applications
- Exposure
- RF applications with intracardiac echocardiography (ICE) visualization vs without ICE visualization
- ICE visualizedn = 1,308
- Outcome
- Steam pops (audible or sudden explosion of microbubbles on ICE)
Methodological detailsconsecutive patients, RF power titrated to a 15 to 20 Ohm impedance fall, adjustable for tissue whitening and bubble formation on ICE
- Consecutive patients
- RF power titrated to a 15 to 20 Ohm impedance fall, adjustable for tissue whitening and bubble formation on ICE
Main finding
As reported in the abstract
Steam pops
P = 0.016
- Pops overall (applications)
- 43 (2.0%)
Observational data: associations, not effects.
Further findings
Predictors of steam pops (multivariable)
| OR | P value | |
|---|---|---|
| Tissue whiteningIndependent of impedance fall and power | 7.186 | P = 0.004 |
| Sudden increase in bubblesIndependent of impedance fall and power | 29.93 | P < 0.001 |
Median, %
| Outcome | Pops | No pops | P value |
|---|---|---|---|
| Impedance decrease at sites with vs without pops | 18 (IQR 14–21) | 13 (IQR 10–17) | P < 0.001 |
Silent pops among ICE-visible pops
- Silent, recognized only as explosion of bubbles on ICE (of 18 ICE-visible pops)
- 7 (39%)
- Pops preceded by tissue whitening or sudden increase in bubbles (with ICE)
- 89%
Safety
- No pericardial effusions or embolic events with steam pops
Original publication
Can Intracardiac Echocardiography Reduce Steam Pops During Half-Normal Saline Irrigated Radiofrequency Ablation? Circ Arrhythm Electrophysiol. Published 28 May 2024. doi:10.
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