Bipolar ablation of therapy-refractory ventricular arrhythmias: application of a dedicated approach

Europace. 2022 Jul 15;24(6):959-969. doi: 10.1093/europace/euab304.


Aims: Bipolar radiofrequency ablation (B-RFA) has been reported as a bail-out strategy for the treatment of therapy refractory ventricular arrhythmias (VA). Currently, existing setups have not been standardized for B-RFA, while the impact of conventional B-RFA approaches on lesion formation remains unclear.

Methods and results: (i) In a multicentre observational study, patients undergoing B-RFA for previously therapy-refractory VA using a dedicated B-RFA setup were retrospectively analysed. (ii) Additionally, in an ex vivo model lesion formation during B-RFA was evaluated using porcine hearts. In a total of 26 procedures (24 patients), acute success was achieved in all 14 ventricular tachycardia (VT) procedures and 7/12 procedures with premature ventricular contractions (PVC), with major complications occurring in 1 procedure (atrioventricular block). During a median follow-up of 211 days in 21 patients, 6/11 patients (VT) and 5/10 patients (PVC) remained arrhythmia-free. Lesion formation in the ex vivo model during energy titration from 30 to 50 W led to similar lesion volumes compared with initial high-power 50 W B-RFA. Lesion size significantly increased when combining sequential unipolar and B-RFA (1429 mm3 vs. titration 501 mm3 vs. B-RFA 50 W 423 mm3, P < 0.001), an approach used in overall 58% of procedures and more frequently applied in procedures without VA recurrence (92% vs. 36%, P = 0.009). Adipose tissue severely limited lesion formation during B-RFA.

Conclusion: Using a dedicated device for B-RFA for therapy-refractory VA appears feasible and safe. While some patients need repeat ablation, success rates were encouraging. Sequential unipolar and B-RFA may be favourable for lesion formation.

Keywords: Bipolar ablation; Premature ventricular contractions; Radiofrequency generator; Ventricular arrhythmias; Ventricular tachycardia.

Publication types

  • Observational Study

MeSH terms

  • Animals
  • Catheter Ablation* / methods
  • Retrospective Studies
  • Swine
  • Tachycardia, Ventricular* / diagnosis
  • Tachycardia, Ventricular* / surgery
  • Treatment Outcome
  • Ventricular Premature Complexes* / diagnosis
  • Ventricular Premature Complexes* / surgery