Clinical Electrophysiology, St. Joseph's Heart Rhythm Center, University of Rzeszów, Anny Jagiellonki 17, 35-623 Rzeszów, Poland.
Heart Center, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany.
Europace. 2024 Oct 3;26(10). doi: 10.1093/europace/euae248.
Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC.
Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%).
These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.
标准单极射频消融（Uni-RFA）难治性室性心动过速（VT）和室性早搏（PVC）需要采用先进的消融策略。双极射频导管消融（Bi-RFA）已成为难治性 VT 和 PVC 的治疗选择。缺乏关于难治性 VT 和 PVC 中使用 Bi-RFA 的多中心注册数据。本 Bi-RFA 注册研究旨在确定其在难治性 VT/PVC 患者中的真实世界安全性、可行性和疗效。
连续 16 家欧洲中心的患者因至少一次 Uni-RFA 后复发 VT/PVC 而行 Bi-RFA，采用双极消融导管，而非分散贴片，置于消融靶点的相反部位。2021 年 3 月至 2024 年 8 月，91 例患者行 94 次 Bi-RFA （74 例男性，年龄 62 ± 13 岁，Uni-RFA 范围 1-8 次）。适应证为 PVC 复发（n = 56）、VT（n = 20）、电风暴（n = 13）或 PVC 触发的心室颤动（n = 2）。手术时间为 160 ± 73 分钟，Bi-RFA 时间 426 ± 286 秒，平均 Uni-RFA 时间 819 ± 697 秒。67 例（74%）患者实现临床 VT/PVC 消除，10 例（11%）患者 VT/PVC 抑制。其余 14 例（15%）患者未观察到 VT/PVC 效果。发生 3 例主要并发症：冠状动脉闭塞、房室传导阻滞和动静脉瘘。随访时间为 7 ± 8 个月。19 例（61%）患者无 VT。45 例（78%）患者 PVC 负荷减少≥80%。
这些真实世界的注册数据表明，Bi-RFA 在大多数 VT/PVC 患者中似乎是安全、可行和有效的。
