Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach

• Published in: Europace (London, England) England), 2022-07, Vol.24 (6), p.959-969
• Main 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
• Format: Article
• Language: English
• Subjects: Animals; Catheter Ablation - methods; Clinical Research; Retrospective Studies; Swine; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - surgery; Treatment Outcome; Ventricular Premature Complexes - diagnosis; Ventricular Premature Complexes - surgery
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euab304

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. (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 mm3 vs. titration 501 mm3 vs. B-RFA 50 W 423 mm3, 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. 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.