Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Souček, Filip; Stárek, Zdeněk

doi:10.2174/1573403x14666180524100608

Cited by 11 publications

(11 citation statements)

References 38 publications

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“…Although steam-pop-related complications were rare in the clinical studies, 10,11 caution is required because experimental studies using a relatively high energy delivery showed a high incidence of steam-pop during BIP ablation. 16,17 The results of this study were similar to the previous clinical and experimental reports on UNIP ablation, 6,7 ) with transmural lesion and without steam-pop, and closed triangle is RF applications (8 times) both with transmural lesion and steam-pop. Averaged myocardial thickness in each 5-ohm-step of TID (Panel A) and in each 5%-step of %TID (Panel B) is shown in the lower column.…”

Section: Steam-pop and Its Predictorssupporting

confidence: 88%

“…However, in several studies, 9,15 these indexes were reported to be insufficient to prevent the occurrence of steam‐pop. Although steam‐pop‐related complications were rare in the clinical studies, 10,11 caution is required because experimental studies using a relatively high energy delivery showed a high incidence of steam‐pop during BIP ablation 16,17 …”

Section: Discussionmentioning

confidence: 99%

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Impedance decrement indexes for avoiding steam‐pop during bipolar radiofrequency ablation: An experimental study using a dual‐bath preparation

Saitoh

Oikawa

Sugai

et al. 2020

Cardiovasc electrophysiol

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Introduction: This experimental study was conducted to explore impedance monitoring for safely performing bipolar (BIP) radiofrequency (RF) ablation targeted to arrhythmia focus. Methods and Results: Using a newly designed dual-bath experimental model, contact-force-controlled (20-g) BIP ablation (50 W, 60 s) was attempted for porcine left ventricle (17.0 ± 2.7 mm thickness). BIP ablation was successfully accomplished for 60 s in 75 of the 89 RF applications (84.3%), whereas audible steam-pop occurred in the other 14 RF applications (15.7%). Receiver operating characteristic analysis demonstrated the optimal predictive values regarding the occurrence of steam-pop as follows; thinner myocardial wall (≤14.8 mm), low minimum impedance (≤89 ohm), greater total impedance decrement (TID) (≤ −25 ohm) and %TID (≤ −22.5%). Greater impedance decrement was not observed immediately preceding the occurrence of steam-pop but appeared around 15 s before. Four steam-pops happened before reaching the optimal predictive values of minimum impedance, whereas all 14 steam-pops developed 11.5 ± 9.2 and 8.1 ± 8.1 s after reaching the optimal predictive values of TID and %TID, respectively. Total lesion depth (endocardial plus epicardial) was 10.7 ± 1.2 mm on average, and was well correlated with TID and %TID. Transmural lesion through the myocardial wall was created in 22 RF applications. Conclusion: Relatively thinner areas of the myocardium are likely to be at greater risk for steam-pop during BIP RF ablation. Lowering the RF application energy to reduce the impedance decrement may help to lessen this risk.

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Section: Steam-pop and Its Predictorssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Impedance decrement indexes for avoiding steam‐pop during bipolar radiofrequency ablation: An experimental study using a dual‐bath preparation

Saitoh

Oikawa

Sugai

et al. 2020

Cardiovasc electrophysiol

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“…There is a substantial discrepancy within the available ex vivo studies regarding steam pop incidence during BPA 10,30 . Importantly, clinical studies have not reported any major complications while ablating in the bipolar mode for miscellaneous arrhythmias 15 . This agrees with our evidence, albeit nonsignificant, of a lower incidence of steam pop in BPA.…”

Section: Discussionsupporting

confidence: 80%

“…A number of in vitro, in vivo, and small‐cohort clinical studies 11‐16 have compared UPA and BPA, suggesting the superiority of the bipolar configuration in creating deep and transmural lesions compared to the standard unipolar configuration 15 . Most of the studies on this topic have used solely linear macroscopic width and depth to characterize the geometry of the lesions.…”

Section: Introductionmentioning

confidence: 99%

Bipolar ablation with contact force‐sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation

Souček

Caluori

Lehar

et al. 2020

Cardiovasc electrophysiol

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Introduction: Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters.Methods: Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality.Results: Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015). Conclusion: Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions. K E Y W O R D S contact force bipolar ablation, radiofrequency catheter ablation, thermal lesion size, ventricular tachycardia

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“…By this configuration, the applied energy produces a rapid rise in tissue temperature and consequent thermal injury (23). Due to this distinctive mechanism of lesion formation, bipolar ablation represents an appealing alternative for creating permanent transmural lesions, especially in deep arrhythmia substrates, as left ventricle papillary muscles, interventricular septum, left ventricular mid-myocardium, or fat-insulated epicardium (24,25).…”

Section: Bipolar Radiofrequency Ablationmentioning

confidence: 99%

Future Perspectives and New “Frontiers” in Cardiac Rhythmology

Anselmino

Ferrari

2020

Front. Cardiovasc. Med.

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Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias

Abstract: To allow wider clinical application the efficiency and safety of bipolar ablation need to be verified in future studies.

Cited by 11 publications

References 38 publications

Impedance decrement indexes for avoiding steam‐pop during bipolar radiofrequency ablation: An experimental study using a dual‐bath preparation

Impedance decrement indexes for avoiding steam‐pop during bipolar radiofrequency ablation: An experimental study using a dual‐bath preparation

Bipolar ablation with contact force‐sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation

Future Perspectives and New “Frontiers” in Cardiac Rhythmology

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