Evaluation of the safety and efficacy of bipolar radiofrequency catheter ablation for the treatment of refractory ventricular arrhythmias

被引:1
作者
Caixal, Gala [1 ]
Waight, Michael [2 ]
Mukherjee, Rahul [1 ]
Pinto, Adriana [1 ]
Grimster, Alexander [1 ]
Li, Anthony [1 ,2 ]
Saba, Magdi [1 ,2 ,3 ]
机构
[1] St Georges Hosp NHS Fdn Trust, London, England
[2] City St Georges Univ London, London, England
[3] Cleveland Clin London, London, England
关键词
Bipolar energy; Ventricular arrhythmias; Radiofrequency catheter ablation; Electroanatomical mapping; Papillary muscle; INTERVENTRICULAR SEPTUM;
D O I
10.1007/s10840-024-01964-y
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundBipolar radiofrequency catheter ablation (B-RFA) has shown promising results in refractory ventricular arrhythmias (VAs) of septal origin and underlying non-ischemic cardiomyopathy. However, its efficacy and safety in other locations, such as papillary muscles (PM) or with different underlying substrates has yet to be fully determined. ObjectiveTo describe the procedure data, safety, and efficacy of B-RFA in a cohort of patients with VAs of different locations and underlying substrates and to generate new hypotheses. MethodsWe prospectively enrolled 26 patients with VAs, of whom 21 ultimately underwent B-RFA during the ablation procedure. Of these, 17 were redo procedures. Thirteen patients presented ventricular tachycardia (VT), and eight patients had ventricular ectopy (VE). Procedure data, related complications and acute and long-term outcomes during follow-up were assessed. ResultsOf the 21 patients, 76.2% were male, and the mean age was 60.8 +/- 15.4 years. Fourteen patients had underlying substrate, and 7 had no structural heart disease. The VA originated from the septum (n = 9), lateral wall (n = 7), and PM (n = 5). Acute success, defined as the absence of the clinical VE or non-inducibility of VT at the end of the procedure, was achieved in 20 patients (95.2%). At 12-month follow-up, 8 (61.5%) patients with VT did not present any sustained arrhythmia or ICD therapy, and 6 (75%) patients with VE had a > 90% reduction in their burden on the 24-h Holter. Papillary muscle VAs seemed to present lower acute and long-term success after B-RFA. The use of B-RFA in PM, compared to other cardiac locations, required a greater number of radiofrequency applications (p = 0.010) with lower mean contact force (p = 0.001) and impedance drop (p = 0.010). No major peri-procedural complications were observed. ConclusionsBipolar RF delivery can be used safely and successfully for VAs of septal and free wall origin but may have more limited use for PM arrhythmias. In this location, B-RFA exhibits reduced energy transfer, as does conventional ablation. No differences in procedural data or outcomes of B-RFA are observed based on the underlying substrate.
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共 33 条
[1]  
Al-Hadithi Ali B A K, 2018, HeartRhythm Case Rep, V4, P557, DOI 10.1016/j.hrcr.2018.01.014
[2]  
Arai Marina, 2019, HeartRhythm Case Rep, V5, P472, DOI 10.1016/j.hrcr.2019.07.002
[3]   Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [J].
Arenal, Angel ;
Avila, Pablo ;
Jimenez-Candil, Javier ;
Tercedor, Luis ;
Calvo, David ;
Arribas, Fernando ;
Fernandez-Portales, Javier ;
Luis Merino, Jose ;
Hernandez-Madrid, Antonio ;
Fernandez-Aviles, Francisco J. ;
Berruezo, Antonio .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2022, 79 (15) :1441-1453
[4]   Long-term results of irrigated bipolar radiofrequency ablation in patients with recurrent arrhythmia after failed unipolar ablation [J].
Baszko, Artur ;
Kochman, Karol ;
Krolak, Tomasz ;
Kalmucki, Piotr ;
Telec, Wojciech ;
Ozegowski, Stefan ;
Szyszka, Andrzej .
MEDICINE, 2020, 99 (21) :E19970
[5]   VT Recurrence After Ablation: Incomplete Ablation or Disease Progression? A Multicentric European Study [J].
Berte, B. ;
Sacher, F. ;
Venlet, J. ;
Andreu, D. ;
Mahida, S. ;
Aldhoon, B. ;
De Potter, T. ;
Sarkozy, A. ;
Tavernier, R. ;
Andronache, M. ;
Deneke, T. ;
Kautzner, J. ;
Berruezo, A. ;
Cochet, H. ;
Zeppenfeld, K. ;
Jais, Pierre .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2016, 27 (01) :80-87
[6]   Bipolar radiofrequency ablation for ventricular tachycardias originating from the interventricular septum: Safety and efficacy in a pilot cohort study [J].
Della Bella, Paolo ;
Peretto, Giovanni ;
Paglino, Gabriele ;
Bisceglia, Caterina ;
Radinovic, Andrea ;
Sala, Simone ;
Baratto, Francesca ;
Limite, Luca Rosario ;
Cireddu, Manuela ;
Marzi, Alessandra ;
D'Angelo, Giuseppe ;
Vergara, Pasquale ;
Gulletta, Simone ;
Mazzone, Patrizio ;
Frontera, Antonio .
HEART RHYTHM, 2020, 17 (12) :2111-2118
[7]   Contact force sensing in ablation of ventricular arrhythmias using a 56-hole open-irrigation catheter: a propensity-matched analysis [J].
Elbatran, Ahmed, I ;
Li, Anthony ;
Gallagher, Mark M. ;
Kaba, Riyaz ;
Norman, Mark ;
Behr, Elijah R. ;
Sohal, Manav ;
Bajpai, Abhay ;
Zuberi, Zia ;
Saba, Magdi M. .
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY, 2021, 60 (03) :543-553
[8]   Bipolar ablation involving coronary venous system for refractory left ventricular summit arrhythmias [J].
Enriquez, Andres ;
Hanson, Matthew ;
Nazer, Babak ;
Gibson, Douglas N. ;
Cano, Oscar ;
Tokioka, Sayuri ;
Fukamizu, Seiji ;
Millan, Pablo Sanchez ;
Hoyos, Carolina ;
Matos, Carlos ;
Sauer, William H. ;
Tedrow, Usha ;
Romero, Jorge ;
Neira, Victor ;
Futyma, Marian ;
Futyma, Piotr .
HEART RHYTHM O2, 2024, 5 (01) :24-33
[9]  
Futyma Piotr, 2023, Card Electrophysiol Clin, V15, P57, DOI 10.1016/j.ccep.2022.07.001
[10]   Anatomic approach with bipolar ablation between the left pulmonic cusp and left ventricular outflow tract for left ventricular summit arrhythmias [J].
Futyma, Piotr ;
Santangeli, Pasquale ;
Puererfellner, Helmut ;
Pothineni, Naga Venkata ;
Gluszczuk, Ryszard ;
Ciapala, Kamil ;
Moroka, Kgomotso ;
Martinek, Martin ;
Futyma, Marian ;
Marchlinski, Francis E. ;
Kulakowski, Piotr .
HEART RHYTHM, 2020, 17 (09) :1519-1527