Bipolar catheter ablation for highly refractory cardiac arrhythmia - does the success rate depend on arrhythmia origin?

• Published in: Europace (London, England) England), 2022-05, Vol.24 (Supplement_1)
• Main Authors: Gardziejczyk, P, Piotrowski, R, Krynski, T, Sikorska, A, Kulakowski, P, Baran, J
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac053.060

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Despite technological progress, some arrhythmias are still refractory to standard unipolar ablation. They include arrhythmias arising from left ventricular (LV) summit, cardiac crux or epicardium. Bipolar ablation may be useful in some cases, however, data on efficacy of this approach in various arrhythmia localisatons are scarse. Purpose Aim of the study was to assess efficacy of bipolar catheter ablation in patients with cardiac arrhythmias refractory to standard ablation approach. Methods Observational, single-center study was conducted over 30-month period. Twenty-six consecutive patients (male=18, aged = 54.26 ± 16.4) who were referred for bipolar ablation were included. All patients had a history of previously failed unipolar ablation procedures. Bipolar ablations were performed using dedicated RF generator and electroanatomic mapping system. Results Twenty-seven procedures in 26 patients with a mean of 2.52 ± 0.83 previously failed unipolar ablations were included in the final analysis. There were 4 ablations of accessory pathways (3 postero-septal and 1 left free wall) with acute success rate of 100%, 11 procedures of ventricular arrhythmias originating from crux of the heart with acute success rate of 73% and 12 from left ventricular summit (LV summit) with acute success rate of 50%. Mid-term success rate (median follow-up of 182 days) was 100%, 63% and 50% respectively. There was one major complication (not related to RF bipolar ablation): cardiac tamponade due to aortic cusp rupture requiring urgent cardiac surgery procedure. Conclusions Bipolar ablation is a promising method of catheter ablation for refractory arrhythmias. The highest success rate was observed in ablation for difficult pathways, followed by ventricular arrhythmias originating from cardiac crux and LV summit.