Key result
Standard unipolar radiofrequency ablation may fail to create lesions of sufficient depth for intramural ventricular arrhythmias, prompting the need for alternative strategies.
Why the study?
Catheter ablation of ventricular arrhythmias can be challenging because standard unipolar radiofrequency ablation rarely penetrates beyond 7 mm and may fail to eliminate intramural substrates.
This paper reviews the prospects and challenges of cryoballoon ablation as an alternative strategy for treating intramural ventricular arrhythmias.
Bipolar ablation may succeed as bail-out for intramural VT; leaves open comparative efficacy versus unipolar approaches.
Catheter ablation of ventricular arrhythmias (VAs) can sometimes be challenging. Radiofrequency energy rarely penetrates beyond 7 mm into the endocardium or epicardium, even with a long duration1. Therefore, standard unipolar radiofrequency ablation (RFA) may fail to create lesions of sufficient depth to eliminate the intramural substrate. There have been several alternative bail-out strategies suggested for intramural VAs to increase success, including simultaneous unipolar RFA, bipolar ablation, use of lower-tonicity catheter irrigation, needle ablation, transvascular ethanol ablation, and stereotactic radioablation2-4.
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Li et al. (2022) conducted a review in Ventricular arrhythmias. Cryoballoon ablation was evaluated. Standard unipolar radiofrequency ablation may fail to create lesions of sufficient depth for intramural ventricular arrhythmias, prompting the need for alternative strategies.
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