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Title: Bipolar radiofrequency catheter ablation for refractory ventricular outflow tract arrhythmias.
Austin Authors: Teh, Andrew W ;Reddy, Vivek Y;Koruth, Jacob S;Miller, Marc A;Choudry, Subbarao;D'Avila, Andre;Dukkipati, Srinivas R
Affiliation: Cardiology Department, Monash University Eastern Health, Victoria, Australia
Department of Cardiology, Austin Hospital, Victoria, Australia
Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York City, New York, USA
Issue Date: 7-Jul-2014
Publication information: Journal of Cardiovascular Electrophysiology 2014; 25(10): 1093-9
Abstract: Standard unipolar radiofrequency ablation (RFA) is typically successful in eliminating premature ventricular contractions (PVCs) originating from the ventricular outflow tract region. In a minority of cases, this approach may be ineffective. We report 4 cases where bipolar RFA was attempted after failed unipolar RFA.From a total of 73 consecutive PVC ablations, 4 patients underwent bipolar RFA after failed unipolar ablation. Three-dimensional electroanatomic activation mapping of the right and left ventricular outflow (RVOT and LVOT), coronary sinus, and aortic root was performed.Mean age was 53 ± 22 years, 3 male. The mean 24-hour PVC burden in these patients was 33,107 ± 8,712. In 3 of 4 patients, the RVOT activation was earlier than the left side. The earliest activation on the left was in the right coronary cusp in 2 patients and left coronary cusp in 2. Unipolar RFA delivered sequentially at the site of earliest RVOT and then earliest aortic cusp sites failed to eradicate the PVCs in all 4 patients. Subsequently, bipolar RFA was applied between irrigated catheters placed at the earliest RVOT and aortic root sites. This approach eliminated PVCs in 3 of 4 (75%) cases. At a median follow-up of 4 months, those with successful bipolar RFA had no recurrence of clinical PVCs.This report demonstrates the potential utility of bipolar RFA in patients with outflow tract PVCs that fail unipolar RFA.
Gov't Doc #: 24890707
DOI: 10.1111/jce.12460
Journal: Journal of cardiovascular electrophysiology
Type: Journal Article
Subjects: catheter ablation
electroanatomic mapping
ventricular tachycardia
Appears in Collections:Journal articles

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