Details

Autor(en) / Beteiligte

• Koruth, Jacob S., MD
• Dukkipati, Srinivas, MD
• Miller, Marc A., MD
• Neuzil, Petr, MD, PhD
• d'Avila, Andre, MD, PhD
• Reddy, Vivek Y., MD

Titel

Bipolar irrigated radiofrequency ablation: A therapeutic option for refractory intramural atrial and ventricular tachycardia circuits

Ist Teil von

• Heart rhythm, 2012-12, Vol.9 (12), p.1932-1941

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Irrigated radiofrequency (RF) ablation can be insufficient to eliminate intramurally located septal atrial flutter (AFL) and ventricular tachycardia (VT) circuits. Bipolar ablation between 2 ablation catheters may be considered for such circuits. Objective To evaluate the utility of bipolar irrigated ablation to terminate arrhythmias resistant to unipolar ablation. Methods In vitro: Bipolar and sequential unipolar RF ablation lesions were placed on porcine ventricular tissue in a saline bath to assess for lesion transmurality. Clinical: 3 patients with atypical septal flutter (AFL), 4 patients with septal VT, and 2 with left ventricle free-wall VT, all of whom failed sequential unipolar RF ablation, underwent bipolar RF ablation using irrigated catheters placed on either surface of the interatria/interventricular septum and left ventricle free-wall, respectively. Results In vitro: Bipolar RF was found to be more likely to achieve transmural lesions (82% vs 33%; P = .001) and could do so in tissues with thicknesses of up to 25 mm. Clinical: All 5 AFLs (3 patients) were successfully terminated with bipolar RF. In follow-up, AFL recurred in 2 of the 3 patients and atrial fibrillation and AFL recurred in 1 of the 3. All 3 thereafter underwent repeat procedures with successful maintenance of sinus rhythm in 2 of the 3 patients (6-month follow-up). In the VT subgroup, 5 of 6 septal VTs and 2 of 3 free-wall VTs were terminated successfully during ablation. In follow-up (12 months), 2 of the 4 patients in the septal bipolar group and 1 of the 2 patients in the free-wall group remained free of VT. Conclusions Bipolar RF can be used to terminate arrhythmias in select patients with tachyarrhythmias.