Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach. Issue 6 (18th December 2021)

• Record Type: Journal Article
• Authors: Kany, Shinwan; Alken, Fares Alexander; Schleberger, Ruben; Baran, Jakub; Luik, Armin; Haas, Annika; Ene, Elena; Deneke, Thomas; Dinshaw, L; Rillig, Andreas; Metzner, Andreas; Reissmann, Bruno; Makimoto, Hisaki; Reents, Tilko; Popa, Miruna Andrea; Deisenhofer, Isabel; Piotrowski, Roman; Kulakowski, Piotr; Kirchhof, Paulus; Scherschel, Katharina; Meyer, Christian
• Is Part Of: Europace. Volume 24:Issue 6(2022)
• Page Start: 959
• Page End: 969
• Publication Date: 2021-12-18
• Subjects: Bipolar ablation -- Ventricular tachycardia -- Ventricular arrhythmias -- Premature ventricular contractions -- Radiofrequency generator; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab304
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Bipolar radiofrequency ablation (B-RFA) has been reported as a bail-out strategy for the treatment of therapy refractory ventricular arrhythmias (VA). Currently, existing setups have not been standardized for B-RFA, while the impact of conventional B-RFA approaches on lesion formation remains unclear. Methods and results: (i) In a multicentre observational study, patients undergoing B-RFA for previously therapy-refractory VA using a dedicated B-RFA setup were retrospectively analysed. (ii) Additionally, in an ex vivo model lesion formation during B-RFA was evaluated using porcine hearts. In a total of 26 procedures (24 patients), acute success was achieved in all 14 ventricular tachycardia (VT) procedures and 7/12 procedures with premature ventricular contractions (PVC), with major complications occurring in 1 procedure (atrioventricular block). During a median follow-up of 211 days in 21 patients, 6/11 patients (VT) and 5/10 patients (PVC) remained arrhythmia-free. Lesion formation in the ex vivo model during energy titration from 30 to 50 W led to similar lesion volumes compared with initial high-power 50 W B-RFA. Lesion size significantly increased when combining sequential unipolar and B-RFA (1429 mm 3 vs. titration 501 mm 3 vs. B-RFA 50 W 423 mm 3, P < 0.001), an approach used in overall 58% of procedures and more frequently applied in procedures without VA recurrence (92% vs. 36%, P = 0.009). Adipose tissue severely limited lesion formation during B-RFA. Conclusion: Using a dedicated device for B-RFA for therapy-refractory VA appears feasible and safe. While some patients need repeat ablation, success rates were encouraging. Sequential unipolar and B-RFA may be favourable for lesion formation. Graphical Abstract: