Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach
Standard
Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach. / 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.
In: EUROPACE, Vol. 24, No. 6, 15.07.2022, p. 959-969.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach
AU - Kany, Shinwan
AU - Alken, Fares-Alexander
AU - Schleberger, Ruben
AU - Baran, Jakub
AU - Luik, Armin
AU - Haas, Annika
AU - Ene, Elena
AU - Deneke, Thomas
AU - Dinshaw, L
AU - Rillig, Andreas
AU - Metzner, Andreas
AU - Reissmann, Bruno
AU - Makimoto, Hisaki
AU - Reents, Tilko
AU - Popa, Miruna-Andrea
AU - Deisenhofer, Isabel
AU - Piotrowski, Roman
AU - Kulakowski, Piotr
AU - Kirchhof, Paulus
AU - Scherschel, Katharina
AU - Meyer, Christian
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
PY - 2022/7/15
Y1 - 2022/7/15
N2 - 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.
AB - 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.
U2 - 10.1093/europace/euab304
DO - 10.1093/europace/euab304
M3 - SCORING: Journal article
C2 - 34922350
VL - 24
SP - 959
EP - 969
JO - EUROPACE
JF - EUROPACE
SN - 1099-5129
IS - 6
ER -
