Bipolar radiofrequency ablation successfully eliminated premature ventricular contractions in 3 of 4 (75%) patients with refractory outflow tract arrhythmias who had failed unipolar ablation.
Case Report (n=4)
Does bipolar radiofrequency ablation eliminate premature ventricular contractions in patients with refractory ventricular outflow tract arrhythmias who failed unipolar ablation?
Bipolar radiofrequency ablation may be an effective salvage strategy for ventricular outflow tract premature ventricular contractions that are refractory to standard unipolar ablation.
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: This report demonstrates the potential utility of bipolar RFA in patients with outflow tract PVCs that fail unipolar RFA.
Teh et al. (Mon,) conducted a case report in Refractory ventricular outflow tract premature ventricular contractions (PVCs) (n=4). Bipolar radiofrequency ablation (RFA) was evaluated on Elimination of PVCs. Bipolar radiofrequency ablation successfully eliminated premature ventricular contractions in 3 of 4 (75%) patients with refractory outflow tract arrhythmias who had failed unipolar ablation.