Andrew W. Teh is the recipient of an Early Career Fellowship from the National Health and Medical Research Council of Australia.
Bipolar Radiofrequency Catheter Ablation for Refractory Ventricular Outflow Tract Arrhythmias
Article first published online: 7 JUL 2014
© 2014 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 25, Issue 10, pages 1093–1099, October 2014
How to Cite
TEH, A. W., REDDY, V. Y., KORUTH, J. S., MILLER, M. A., CHOUDRY, S., D'AVILA, A. and DUKKIPATI, S. R. (2014), Bipolar Radiofrequency Catheter Ablation for Refractory Ventricular Outflow Tract Arrhythmias. Journal of Cardiovascular Electrophysiology, 25: 1093–1099. doi: 10.1111/jce.12460
Drs. Reddy and Dukkipati have received consulting fees, grant funding, and served on the advisory board for Biosense Webster. Dr. d’Avila has received consulting fees from Biosense Webster. Other authors: No disclosures.
- Issue published online: 10 OCT 2014
- Article first published online: 7 JUL 2014
- Accepted manuscript online: 2 JUN 2014 03:34AM EST
- Manuscript Accepted: 19 MAY 2014
- Manuscript Revised: 12 MAY 2014
- Manuscript Received: 17 MAR 2014
- catheter ablation;
- electroanatomic mapping;
- ventricular tachycardia
Bipolar Ablation for Outflow Tract VT
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.