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  • Title: Bipolar radiofrequency catheter ablation for refractory ventricular outflow tract arrhythmias.
    Author: Teh AW, Reddy VY, Koruth JS, Miller MA, Choudry S, D'Avila A, Dukkipati SR.
    Journal: J Cardiovasc Electrophysiol; 2014 Oct; 25(10):1093-9. PubMed ID: 24890707.
    Abstract:
    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.
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