Bipolar catheter ablation in ventricular myocardium.
bipolar ablation
catheter radiofrequency ablation
unipolar ablation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
31
08
2019
revised:
17
10
2019
accepted:
11
11
2019
pubmed:
14
11
2019
medline:
23
2
2021
entrez:
14
11
2019
Statut:
ppublish
Résumé
Recurrence rates after catheter radiofrequency ablation (RFA) for arrhythmias arising from deep myocardial substrates can exceed 40%. Failure of RFA is in part due to the inability of widely used unipolar ablation (UA) to create transmural lesions capable of disrupting the critical components of the arrhythmia circuit. A radiofrequency generator was custom-made to deliver bipolar ablation (BA) to test the hypothesis that BA is more effective compared to UA in achieving transmurality and to determine the optimal configuration for ventricular BA. Sequential UA and BA were created in porcine ventricular septal and free wall preparations using irrigated, contact-force sensing ablation catheters, orientated perpendicularly to the myocardium. Return catheters, durations of ablation, irrigating fluids, and power settings were varied to determine the optimal configuration for BA. Lesion characteristics, transmurality, and occurrence of steam pops were analyzed. In both ventricular septal and free wall models, BA resulted in significantly more transmural lesions while causing less steam pops (P < .01). BA lesions were deeper, narrower but larger in volume. Use of 8 mm ground catheters in the epicardium resulted in overheating during BA with temperatures exceeding 95°C, limiting power delivery. Increasing duration and powers of BA resulted in progressively larger lesions and increased transmurality (all P < .01), and 0.45% saline as the irrigation did not enhance BA. BA created larger lesions with increased chances of transmurality but at lower risks of steam pops. Use of an irrigated catheter as the return electrode and 30 W of BA delivered over 120 seconds provides the optimal balance between creating deep, transmural lesions and avoiding steam pops.
Sections du résumé
BACKGROUND
Recurrence rates after catheter radiofrequency ablation (RFA) for arrhythmias arising from deep myocardial substrates can exceed 40%. Failure of RFA is in part due to the inability of widely used unipolar ablation (UA) to create transmural lesions capable of disrupting the critical components of the arrhythmia circuit. A radiofrequency generator was custom-made to deliver bipolar ablation (BA) to test the hypothesis that BA is more effective compared to UA in achieving transmurality and to determine the optimal configuration for ventricular BA.
METHODS
Sequential UA and BA were created in porcine ventricular septal and free wall preparations using irrigated, contact-force sensing ablation catheters, orientated perpendicularly to the myocardium. Return catheters, durations of ablation, irrigating fluids, and power settings were varied to determine the optimal configuration for BA. Lesion characteristics, transmurality, and occurrence of steam pops were analyzed.
RESULTS
In both ventricular septal and free wall models, BA resulted in significantly more transmural lesions while causing less steam pops (P < .01). BA lesions were deeper, narrower but larger in volume. Use of 8 mm ground catheters in the epicardium resulted in overheating during BA with temperatures exceeding 95°C, limiting power delivery. Increasing duration and powers of BA resulted in progressively larger lesions and increased transmurality (all P < .01), and 0.45% saline as the irrigation did not enhance BA.
CONCLUSION
BA created larger lesions with increased chances of transmurality but at lower risks of steam pops. Use of an irrigated catheter as the return electrode and 30 W of BA delivered over 120 seconds provides the optimal balance between creating deep, transmural lesions and avoiding steam pops.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-61Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Tokuda M, Kojodjojo P, Tung S, et al. Acute failure of catheter ablation for ventricular tachycardia due to structural heart disease: causes and significance. J Am Heart Assoc. 2013;2:e000072.
Bugge E, Nicholson IA, Thomas SP. Comparison of bipolar and unipolar radiofrequency ablation in an in vivo experimental model. Eur J Cardiothorac Surg. 2005;28:76-80. discussion 80-72.
Gizurarson S, Spears D, Sivagangabalan G, et al. Bipolar ablation for deep intra-myocardial circuits: human ex vivo development and in vivo experience. Europace. 2014;16:1684-1688.
Koruth JS, Dukkipati S, Miller MA, Neuzil P, d'Avila A, Reddy VY. Bipolar irrigated radiofrequency ablation: a therapeutic option for refractory intramural atrial and ventricular tachycardia circuits. Heart Rhythm. 2012;9:1932-1941.
Lee C, Choi EK, Kong HJ, Choy YB, Kim HC, Oh S. Generating radiofrequency ablation lesions using magnetically coupled bipolar catheters. Pacing Clin Electrophysiol. 2011;34:934-938.
Nagashima K, Watanabe I, Okumura Y, et al. Lesion formation by ventricular septal ablation with irrigated electrodes: comparison of bipolar and sequential unipolar ablation. Circ J. 2011;75:565-570.
Nagashima K, Watanabe I, Okumura Y, et al. Epicardial ablation with irrigated electrodes: - effect of bipolar vs. unipolar ablation on lesion formation. Circ J. 2012;76:322-327.
Nguyen DT, Tzou WS, Brunnquell M, et al. Clinical and biophysical evaluation of variable bipolar configurations during radiofrequency ablation for treatment of ventricular arrhythmias. Heart Rhythm. 2016;13:2161-2171.
Sivagangabalan G, Barry MA, Huang K, et al. Bipolar ablation of the interventricular septum is more efficient at creating a transmural line than sequential unipolar ablation. Pacing Clin Electrophysiol. 2010;33:16-26.
Sauer PJ, Kunkel MJ, Nguyen DT, Davies A, Lane C, Tzou WS. Successful ablation of ventricular tachycardia arising from a midmyocardial septal outflow tract site utilizing a simplified bipolar ablation setup. HeartRhythm Case Rep. 2019;5:105-108.
Nguyen DT, Gerstenfeld EP, Tzou WS, et al. Radiofrequency ablation using an open irrigated electrode cooled with half-normal saline. JACC Clin Electrophysiol. 2017;3:1103-1110.
Martin-Suarez S, Claysset B, Botta L, et al. Surgery for atrial fibrillation with radiofrequency ablation: four years’ experience. Interact Cardiovasc Thorac Surg. 2007;6:71-76.
Merino JL, Peinado R, Ramirez L, Echeverria I, Sobrino JA. Ablation of idiopathic ventricular tachycardia by bipolar radiofrequency current application between the left aortic sinus and the left ventricle. Europace. 2000;2:350-354.
Teh AW, Reddy VY, Koruth JS, et al. Bipolar radiofrequency catheter ablation for refractory ventricular outflow tract arrhythmias. J Cardiovasc Electrophysiol. 2014;25:1093-1099.
Futyma P, Ciąpała K, Głuszczyk R, Sander J, Futyma M, Kułakowski P. Bipolar ablation of refractory atrial and ventricular arrhythmias: importance of temperature values of intracardiac return electrodes. J Cardiovasc Electrophysiol. 2019;30:1718-1726.