Bipolar radiofrequency ablation for ventricular tachycardias originating from the interventricular septum: Safety and efficacy in a pilot cohort study

Bipolar Radiofrequency Ablation of Septal Ventricular Tachycardia Facilitated by an Intramural Catheter

“…Therefore, placing the 2-F octapolar catheter intraseptally, in the region of the likely substrate, may have focused the ablation on the intraseptal substrate and augmented the transmural effect of bipolar RF delivery. The loss of capture from the 2-F octapolar catheter seen after 5 minutes 49 seconds of bipolar RF ablation compares favorably to a published mean of 10 ± 5 minutes ( 2 ), thereby supporting this “antenna effect” theory. However, this mechanism requires further validation in clinical studies.…”

“…This is important to recognize because midwall substrate may be difficult to identify accurately from either ventricle, and standard unipolar ablation may fail to create lesions of sufficient depth to abolish the substrate. In a recent series of patients with nonischemic cardiomyopathy and VT who were undergoing bipolar RF ablation, the presence of septal scar was associated with better outcomes compared with extraseptal scar, and the only anatomical limitation to bipolar RF ablation was septal thinning, with an intercatheter distance of <5 mm ( 2 ). Our patient had a significant septal scar, and the septal thickness was sufficient for bipolar ablation at 9 mm.…”

Atrial Fibrillation Ablation Using Vein of Marshall Ethanol Infusion

“…Similar safety concerns have also been noted in the multicenter bipolar VT study that was halted due to a higher-than-expected rate of adverse events. 19 More recently, Della 20 These data point toward use of this technique in specialized centers with experience in this technology.…”

Updates in Ventricular Tachycardia Ablation

“…Recently Della Bella et al, 105) reported the safety and efficacy of bipolar ablation in a prospective pilot study of 21 patients with NICM and drug-refractory VT from the IVS. The bipolar ablation group was compared with patients with <5 mm IVS wall thickness, or non-septal VTs, or extra IVS substrate.…”