Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting

Abstract

Purpose To make an in vitro evaluation of the lesion size and depth produced in two different sets of radio frequency energy bipolar delivery: simultaneous biparietal bipolar (SBB) and simultaneous uniparietal bipolar (SUB). Methods Two separate prototypes have been built for our purpose: one to be used in SBB mode and the other to be used SUB mode. Forty left atrium samples were taken from the hearts of freshly slaughtered pigs. They were ablated into a simulator ABLABOX, where blood flow, temperature, and contact force were controlled. After being sliced into a cryotome, the samples were digitalized by a flatbed scanner, and the images were analyzed by a computer morphometric software. Results Transmural lesions were achieved in 18/20 samples (90%) in SBB, while SUB showed transmurality in 9/20 samples (45%). Overall maximum diameter (DMAX) resulted larger in SUB than in SBB (2.43 ± 0.30 mm, 1.62 ± 0.14 mm, respectively; p < 0.05): Moreover, maximum epicardial and endocardial diameters (DEPI and DENDO, respectively) were wider in SUB group than SBB group (2.28 ± 0.30 mm, 2.26 ± 0.40 and 1.60 ± 0.14 mm, 1.59 ± 0.15 mm, respectively; p < 0.05). We observed the same tendency in lesion depth: The total area and volume (ATOT and VTOT) were broader in SUB group than in SBB one (581.01 ± 65.38 mm/mm2, 58.10 ± 6.53 mm/mm3 and 521.97 ± 73.05 mm/mm2, 52.19 ± 7.30 mm/mm3. respectively; p < 0.05). Conclusions In contrast with the smaller lesion sizes, the biparietal bipolar group showed a higher transmurality rate. These findings may suggest a better drive of the energy flow when compared with SUB lesions.

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

“…They have two parallel jaws, a curved upper jaw and a lower jaw, which can realize full and continuous contact between the electrode and the tissue when clamping the lesion tissue, creating a continuous ablation pathway and determining whether the tissue has reached complete wall permeability through the change of electrical conductivity. In addition, the parallel clamp design can avoid local energy concentration and reduce the damage to some low-impedance tissues (esophagus) ( 15 ).…”

Epicardial box lesion using bipolar biparietal radiofrequency and multimodality scar evaluation—a case series

“…The biparietal bipolar RF energy delivery yields higher transmurality rates in comparison to uniparietal approach. 5 The use of irrigated bipolar RF energy generates larger and more effective lesions compared with non-irrigated RF ablation. 6 The complete and consistent tissue contact leads to consistent and evenly applied energy delivery resulting in a robust lesion.…”

In vivo preliminary test of a new biparietal bidirectional bipolar radiofrequency magnetic coupling system

“…In vitro, we have recently confirmed both that a biparietal bipolar mode yields a higher transmurality rate compared to a simultaneous uniparietal bipolar set‐up and that different time sequences of combined epi‐endo ablation do not result in an acceptable transmural lesion rate. 6 , 7 In contrast with the latter evidence, in the hybrid approach with either a single or two‐stage procedures, 8 the standard procedure prescribes that the electrophysiologist, although he or she can make lesions independently from the surgeon, should make lesions after the surgeon has completed the epicardial surgical ablation and only if a residual gap is being detected within the lesion area. Nonetheless, although the hybrid technique results in an increased rate of freedom from AF recurrence, compared to endocardial catheter and surgical epicardial ablation alone, 2 undetected reconnections may occur after some time even though a complete conduction block should be detected immediately after the procedure.…”

“…In this regard, we have recently started developing a proof‐of‐concept for an endo/epicardial biparietal bidirectional bipolar radiofrequency (RF) tool prototype such that the atrial tissue is fully interposed between the two RF poles. The advantage of this tool is a lower amount of tissue interposed between the catheters and a lower chance of creating folds, thus increasing the likelihood of lesion transmurality 6 . In this preliminary study, the effectiveness, feasibility, and safety of a new RF biparietal bipolar prototype was tested in four pigs to evaluate the potential of this novel technology and explore the possibility of future developments and the possible need of more extensive targeted animal tests.…”

“…The advantage of this tool is a lower amount of tissue interposed between the catheters and a lower chance of creating folds, thus increasing the likelihood of lesion transmurality. 6 In this preliminary study, the effectiveness, feasibility, and safety of a new RF biparietal bipolar prototype was tested in four pigs to evaluate the potential of this novel technology and explore the possibility of future developments and the possible need of more extensive targeted animal tests.…”