Why the study?
Does changing the bipolar-to-unipolar ratio of energy delivery from 2:1 to 4:1 improve safety and efficacy during phased RF ablation for atrial fibrillation?
Does changing the bipolar-to-unipolar ratio of energy delivery from 2:1 to 4:1 improve safety and efficacy during phased RF ablation for atrial fibrillation?
Changing the bipolar-to-unipolar ratio from 2:1 to 4:1 during phased RF ablation may allow effective lesion creation while mitigating esophageal temperature rise.
Esophageal temperature rise may preclude safe phased RF delivery; case report leaves open need for refined single-catheter PVI techniques.
Phased radiofrequency ablation with a single catheter technique, using a 9-electrode circumferential catheter, is a viable approach to pulmonary vein isolation for the treatment of atrial fibrillation. However, creating effective transmural lesions with such technique, while avoiding serious complications like atrioesophageal fistula, can be difficult. This case illustrates a challenging scenario, where catheter maneuvers fail to allow safe radiofrequency delivery, due to esophageal temperature rise, despite extensive navigating maneuvers. Changing the bipolar-to-unipolar ratio of energy delivery, from 2:1 to 4:1, allowed the creation of effective lesions, avoiding excessive increase in esophageal temperature.
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Dorfman et al. (2016) studied this question.
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