Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Heart Rhythm. 2020 Sep;17(9):1500-1507. doi: 10.1016/j.hrthm.2020.04.028. Epub 2020 Apr 28.
Successful bipolar radiofrequency catheter ablation (RFCA) of refractory ventricular arrhythmias (VAs) has been reported. However, the efficacy, safety, and long-term outcomes of bipolar RFCA of VAs are not fully determined.
The purpose of this study was to evaluate the effectiveness and safety of bipolar RFCA in treating refractory VAs during long-term follow-up.
Eighteen patients who underwent bipolar RFCA for ventricular tachycardia (VT) at 7 institutions were retrospectively investigated. Underlying heart diseases included remote myocardial infarction (n = 3 [17%]) and nonischemic cardiomyopathy (n = 15 [83%]). Although unipolar RFCA was performed in all patients, either it failed to suppress VT or VT recurred. The interventricular septum, left ventricular free wall, and left ventricular summit were targeted for bipolar RFCA.
Acute success (VT termination and/or noninducibility) was achieved with bipolar RFCA in 16 patients (89%). Complications during the procedure included complete atrioventricular block (n = 2) and coronary artery stenosis (n = 1). One patient underwent chemical ablation after bipolar RFCA failure. At 12-month follow-up, VT reoccurred in 8 patients (44%). However, in patients with recurrence, VT burden had decreased: only 4 patients underwent re-RFCA, and only 1 of the 4 required chemical ablation. In the remaining 4 patients, re-RFCA was not required, as VT was controlled by medication or an implantable cardioverter-defibrillator.
Bipolar RFCA is useful for acute suppression of refractory VT. Although VT recurrence rates during long-term follow-up were relatively high, we observed a significant reduction in VT burden.
已有研究报道，成功实施双极射频导管消融（RFCA）可治疗难治性室性心律失常（VA）。然而，双极 RFCA 治疗 VA 的疗效、安全性和长期预后尚不完全明确。
本研究旨在评估双极 RFCA 治疗难治性 VA 的有效性和安全性及其长期随访结果。
回顾性分析了 7 家医疗机构的 18 例行双极 RFCA 治疗室性心动过速（VT）的患者。基础心脏病包括陈旧性心肌梗死（n=3[17%]）和非缺血性心肌病（n=15[83%]）。所有患者均接受了单极 RFCA，但 VT 均未得到抑制或复发。双极 RFCA 的消融靶点为室间隔、左心室游离壁和左心室心尖部。
16 例（89%）患者即刻获得双极 RFCA 成功（VT 终止和/或不可诱导性）。手术过程中的并发症包括完全性房室传导阻滞（n=2）和冠状动脉狭窄（n=1）。1 例患者在双极 RFCA 失败后接受了化学消融。12 个月随访时，8 例患者（44%）VT 复发。然而，在复发患者中，VT 负荷降低：仅 4 例患者再次行 RFCA，其中仅 1 例需要化学消融。其余 4 例患者，因 VT 得到药物或植入式心脏复律除颤器的控制而无需再次行 RFCA。
双极 RFCA 可有效即刻抑制难治性 VT。尽管长期随访中 VT 复发率相对较高，但我们观察到 VT 负荷显著降低。
