Key result
Bipolar radiofrequency catheter ablation using an 8 mm intracardiac return electrode resulted in significantly lower maximal temperatures compared to a 4 mm electrode (43°C vs 63°C; P=0.027).
Why the study?
Data on safety issues of bipolar radiofrequency catheter ablation, including temperature values of intracardiac return electrodes, were lacking.
Does the use of an 8 mm versus a 4 mm intracardiac return electrode improve the safety profile (lower temperatures and fewer steam-pops) during bipolar radiofrequency catheter ablation in patients with refractory arrhythmias?
Observational (n=19)
No
Does the use of an 8 mm versus a 4 mm intracardiac return electrode improve the safety profile (lower temperatures and fewer steam-pops) during bipolar radiofrequency catheter ablation in patients with refractory arrhythmias?
Absolute Event Rate: 63% vs 43%
p-value: p=.027
Using an 8 mm rather than a 4 mm intracardiac return electrode during bipolar radiofrequency catheter ablation is associated with lower temperatures and fewer steam-pops, suggesting a better safety profile.
May favor 8 mm over 4 mm electrodes to limit temperatures in bipolar RFCA; hypothesis-generating, requiring randomized confirmation before practice change.
INTRODUCTION: Bipolar radiofrequency catheter ablation (Bi-RFCA) emerged as an option for treatment of arrhythmias resistant to the conventional approach. Data on safety issues of Bi-RFCA, including temperature values of intracardiac return electrode (IRE) are lacking. OBJECTIVE: To determine the safety profile of Bi-RFCA regarding temperature measurements obtained from nonirrigated IRE of different sizes. METHODS: The study group consisted of consecutive patients after failed conventional RFCA who underwent Bi-RFCA. RESULTS: Out of 1510 RFCA performed in our center, 19 patients underwent Bi-RFCA due to refractory to previous RFCA ventricular arrhythmias (15 patients) or typical atrial flutter (four patients). Nonirrigated small (4 mm) and large (8 mm) tip catheters were used as IRE in 14 (including three cross-overs to 8 mm IRE) and five patients, respectively. A total number of 164 bipolar applications were performed (128 for 4 mm and 36 for 8 mm IRE). Maximal temperatures of 4 mm IRE were significantly higher than those of 8 mm IRE (63°C ± 16°C vs 43°C ± 4°C; P = .027). A significant rise of temperature and steam-pops, preventing further Bi-RFCA, occurred in seven patients treated with 4 mm IRE. Bi-RFCA using 4 mm IRE operated at significantly higher impedance values (211 ± 83 vs 143 ± 38; P = .04) and lower power values (mean 20 W ± 6 W vs 32 W ± 7 W, P = .0005; max 29 W ± 9 W vs 39 W ± 10 W, P = .027). CONCLUSION: The use of 8 mm IRE for Bi-RFCA is associated with lower temperatures of the catheter used as ground and lower incidence of steam-pops which may suggest a better safety profile than 4 mm IRE. Determination of safety/efficacy balance requires further studies.
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Futyma et al. (2019) conducted an observational in Refractory atrial and ventricular arrhythmias (n=19). Bipolar radiofrequency catheter ablation using 4 mm intracardiac return electrode vs. 8 mm intracardiac return electrode was evaluated on Maximal temperatures of intracardiac return electrode (p=.027). Bipolar radiofrequency catheter ablation using an 8 mm intracardiac return electrode resulted in significantly lower maximal temperatures compared to a 4 mm electrode (43°C vs 63°C; P=0.027).
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