Details

Autor(en) / Beteiligte

• 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

Titel

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

Ist Teil von

• Europace (London, England), 2022-07, Vol.24 (6), p.959-969

Ort / Verlag

England: Oxford University Press

Erscheinungsjahr

2022

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• 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.