https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinik Schleswig-Holstein, Campus Kiel Klinik für Kardiologie und internistische Intenisvmedizin Kiel, Deutschland; 2Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland; 3Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie und internistische Intensivmedizin Kiel, Deutschland
Background: Catheter ablation has emerged as a primary choice of treatment for many arrhythmias. While unipolar ablation is sufficient in the treatment of the majority of arrhythmias, its acute and long term efficacy can be limited in specific cases. In particular, eliminating intramural arrhythmic origins remains challenging, as unipolar ablation can fail to create transmural lesions. Bipolar ablation is proposed as an alternative to overcome unipolar ablation limitations.
Aim: The aim of the study was to assess the ablation settings as well as periprocedural success of bipolar catheter ablation in a big tertiary ablation center.
Methods and Results: All patients who underwent CA between September 2022 and October 2024 were screened retrospectively for bipolar catheter ablation. Sixteen patients were identified (median age 68 [61;81], 13% female, median BMI 27 [24;31], median ejection fraction 49 [36;57]). 11/16 (69%) underwent catheter ablation of ventricular tachycardia (VT), 5 of those patients presented with VT storm. In 5/16 patients, catheter ablation was performed due to symptomatic premature ventricular contractions. In 7 of the 16 patients the procedure was performed after a previously failed procedure (1.6 previous procedures). All procedures were performed under conscious sedation (CS) with propofol and fentanyl. In 7/16 patients bipolar ablation of the interventricular septum was performed. In 4/16 patients bipolar ablation was performed between coronary sinus and LV and in 2/16 patients bipolar ablation was done between epicardial and endocardial LV after establishing an epicardial access. Median number of RF applications were 8 [6;10] with a median of 180 [174;322] seconds of RF ablation time. Average impedance drop during ablation was 15 [13;17]. Total procedure time was 180 [13;17] minutes. Bipolar ablation was successful in 12/16 patients. After a mean follow up of 8 months, one patient with acute success experienced recurrence of the tachycardia. In one patient, with previously implanted pacemaker, AV block occurred after bipolar ablation. No other peri- or postprocedural complications occurred.
Conclusion
Bipolar catheter ablation is an effective tool by targeting different arrhythmias with an intramural origin. It is shown to be safe with a high acute success rate in patients presenting with VT or PVC.