Miyako Igarashi1, Akihiko Nogami2, Seiji Fukamizu3, Yukio Sekiguchi1, Junichi Nitta4, Naka Sakamoto5, Yuichiro Sakamoto6, Kenji Kurosaki7, Yoshihide Takahashi8, Akira Kimata1, Yuki Komatsu1, Takeshi Machino1, Kenji Kuroki1, Hiro Yamasaki1, Kazutaka Aonuma1, Masaki Ieda1. 1. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 2. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. Electronic address: anogami@md.tsukuba.ac.jp. 3. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. 4. Department of Cardiology, Saitama Red Cross Hospital, Saitama, Japan. 5. Department of Cardiology, Asahikawa Medical University, Hokkaido, Japan. 6. Department of Cardiology, Toyohashi Heart Center, Aichi, Japan. 7. Department of Heart Rhythm Management, Yokohama Rosai Hospital, Kanagawa, Japan. 8. Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan.
Abstract
BACKGROUND: Successful bipolar radiofrequency catheter ablation (RFCA) of refractory ventricular arrhythmias (VAs) has been reported. However, the efficacy, safety, and long-term outcomes of bipolar RFCA of VAs are not fully determined. OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety of bipolar RFCA in treating refractory VAs during long-term follow-up. METHODS: Eighteen patients who underwent bipolar RFCA for ventricular tachycardia (VT) at 7 institutions were retrospectively investigated. Underlying heart diseases included remote myocardial infarction (n = 3 [17%]) and nonischemic cardiomyopathy (n = 15 [83%]). Although unipolar RFCA was performed in all patients, either it failed to suppress VT or VT recurred. The interventricular septum, left ventricular free wall, and left ventricular summit were targeted for bipolar RFCA. RESULTS: Acute success (VT termination and/or noninducibility) was achieved with bipolar RFCA in 16 patients (89%). Complications during the procedure included complete atrioventricular block (n = 2) and coronary artery stenosis (n = 1). One patient underwent chemical ablation after bipolar RFCA failure. At 12-month follow-up, VT reoccurred in 8 patients (44%). However, in patients with recurrence, VT burden had decreased: only 4 patients underwent re-RFCA, and only 1 of the 4 required chemical ablation. In the remaining 4 patients, re-RFCA was not required, as VT was controlled by medication or an implantable cardioverter-defibrillator. CONCLUSION: Bipolar RFCA is useful for acute suppression of refractory VT. Although VT recurrence rates during long-term follow-up were relatively high, we observed a significant reduction in VT burden.
BACKGROUND: Successful bipolar radiofrequency catheter ablation (RFCA) of refractory ventricular arrhythmias (VAs) has been reported. However, the efficacy, safety, and long-term outcomes of bipolar RFCA of VAs are not fully determined. OBJECTIVE: The purpose of this study was to evaluate the effectiveness and safety of bipolar RFCA in treating refractory VAs during long-term follow-up. METHODS: Eighteen patients who underwent bipolar RFCA for ventricular tachycardia (VT) at 7 institutions were retrospectively investigated. Underlying heart diseases included remote myocardial infarction (n = 3 [17%]) and nonischemic cardiomyopathy (n = 15 [83%]). Although unipolar RFCA was performed in all patients, either it failed to suppress VT or VT recurred. The interventricular septum, left ventricular free wall, and left ventricular summit were targeted for bipolar RFCA. RESULTS: Acute success (VT termination and/or noninducibility) was achieved with bipolar RFCA in 16 patients (89%). Complications during the procedure included complete atrioventricular block (n = 2) and coronary artery stenosis (n = 1). One patient underwent chemical ablation after bipolar RFCA failure. At 12-month follow-up, VT reoccurred in 8 patients (44%). However, in patients with recurrence, VT burden had decreased: only 4 patients underwent re-RFCA, and only 1 of the 4 required chemical ablation. In the remaining 4 patients, re-RFCA was not required, as VT was controlled by medication or an implantable cardioverter-defibrillator. CONCLUSION:Bipolar RFCA is useful for acute suppression of refractory VT. Although VT recurrence rates during long-term follow-up were relatively high, we observed a significant reduction in VT burden.
Authors: 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 Journal: Europace Date: 2022-07-15 Impact factor: 5.486