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

Autor: Shinwan Kany, Fares Alexander Alken, Ruben Schleberger, Jakub Baran, Armin Luik, Annika Haas, Elena Ene, Thomas Deneke, L Dinshaw, Andreas Rillig, Andreas Metzner, Bruno Reissmann, Hisaki Makimoto, Tilko Reents, Miruna Andrea Popa, Isabel Deisenhofer, Roman Piotrowski, Piotr Kulakowski, Paulus Kirchhof, Katharina Scherschel, Christian Meyer
Rok vydání: 2021
Předmět:
Zdroj: Europace
ISSN: 1532-2092
1099-5129
DOI: 10.1093/europace/euab304
Popis: 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 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. 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.
Databáze: OpenAIRE
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