Bipolar Radiofrequency Ablation of Ventricular Arrhythmias Originating in the Vicinity of His Bundle

Futyma, Piotr; Ciąpała, Kamil; Sander, Julia; Głuszczyk, Ryszard; Futyma, Marian; Kułakowski, Piotr

doi:10.1161/circep.119.008165

Cited by 21 publications

(19 citation statements)

References 5 publications

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“…Steam pop occurred as a result of BA in 3.6% and 6.7%, respectively, at power settings of 30 and 50 W, compared to 15.4%, and 45.8%, respectively, at the same power settings with sequential UA. Consistent with recent relevant studies, 13,24 our preliminary experience demonstrated the safety of BA in the OT area.…”

Section: Follow-upsupporting

confidence: 89%

Bipolar catheter ablation strategies for outflow tract ventricular arrhythmias refractory to unipolar ablation

Zhou

et al. 2022

Cardiovasc electrophysiol

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Introduction: Conventional unipolar catheter ablation (UA) is generally effective for the treatment of outflow tract ventricular arrhythmias (OT-VAs). However, deep foci refractory to UA remains a clinical challenge. The present study evaluated the efficacy and safety of bipolar ablation (BA) in the treatment of OT-VAs refractory to UA. Methods: A total of 1022 consecutive patients with antiarrhythmic drugs resistant OT-VAs were screened for inclusion in this study, from 1643 VAs cases who underwent catheter ablation in two centers from October 2014 to May 2019. BA was performed after failed sequential UA. The pair of catheters used for BA was positioned on opposing surfaces of the earliest activation (EA) sites or on adjacent anatomical structures.Results: Twelve patients (seven males, mean age 33.3 ± 16.2 years) who met the inclusion criteria were recruited: one patient suffered sustained monomorphic ventricular tachycardia (VT), six patients had frequent premature ventricular contractions (PVCs), and nonsustained VT (NSVT), and five patients had PVCs only.The 24-hPVC/NSVT burden was 36.9 ± 21.7%. The mean distance between two ablation catheters during BA was 11.1 ± 4.3 mm (range 6.5-23.9 mm). The "rS" morphology of the unipolar electrogram was recorded simultaneously in both EA regions in seven cases (58.3%). Acute eradication of VAs was obtained in 10 (83.3%) cases. At a median follow-up of 58 months, 10 patients (83.3%) remained free from VAs.Conclusion: BA was highly effective and safe for the treatment of OT-VAs refractory to UA.

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Section: Follow-upsupporting

confidence: 89%

Bipolar catheter ablation strategies for outflow tract ventricular arrhythmias refractory to unipolar ablation

Zhou

et al. 2022

Cardiovasc electrophysiol

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“…However, this technique was feasible in few patients with VAs from the superior septal region especially the para-hisian region because the space between septal cusps of the TA and septal wall of the right ventricle was extremely narrow. The pacing technique 14 or low energy bipolar ablation 15 may improve the efficacy and safety for ablation in this region although there is little experience in our institution. An irrigated-tip electrode is extremely necessary for energy delivery in procedures with the reversed U-curve ablation technique because of tight contact.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the vicinity of tricuspid annulus

Ming

Hou

et al. 2021

Sci Rep

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Electrocardiographic and electrophysiological characteristics of VAs originating from the vicinity of the TA are not fully understood. Hence, 104 patients (mean age 52.6 ± 17.9 years; 62 male) with VAs originating from the vicinity of the TA were enrolled. After electrophysiological evaluation and ablation, data were compared among those patients. The ECGs and the correction of the ECGs based on the long axis of the heart calculated from the chest X-Ray were also analyzed. VAs originating from the vicinity of TA had distinctive ECG characteristics that were useful for identifying the precise origin. Our localization algorithm adjusted by the angle between the cardiac long axis and the horizon was found to be accurate in predicting the exact ablation site in 92.3% (n = 96) cases. Logistic regression analysis showed fractionated electrograms, the magnitudes of the local atrial electrograms and a/V ratio were critical factors for successful ablation. Among the 104 patients with VAs, complete elimination could be achieved by RFCA in 96 patients (success rate 92.3%) during a follow-up period of 35.2 ± 19.6 months. This study suggests that the ablation site could be localized by ECG analysis adjusted by the angle between the cardiac long axis and the horizon. Fractionated electrograms, the magnitudes of the local atrial electrograms and a/V ratio were demonstrated to be critical factors for successful ablation.

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“…Radiofrequency ablation of VT from the His bundle is commonly applied and has been effective in previous cases[ 16 ]. Pacemaker implantation has been found to improve patient health and quality of life in other studies[ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia originating from the His bundle: A case report

Zhang¹,

Dong²,

Yu³

et al. 2021

WJCC

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BACKGROUND Ventricular tachycardia (VT) commonly occurs among patients with heart failure and can even cause sudden cardiac death. VT originating from the His bundle branch has been rarely reported. We present the case of a patient with VT from the His bundle branch. CASE SUMMARY A 58-year-old female complained of paroxysmal palpitations and dizziness for approximately 6 mo. She had a history of fatty liver and cholecystitis, and carotid atherosclerosis could not be excluded from the ultrasound results. An evaluation of the electrocardiogram obtained after admission showed spontaneous conversion between two different morphologies. The possible electrophysiologic mechanism suggested that the dual-source VT originated from the same source, the His bundle branch. Finally, the His bundle branch was ablated, and a dual-chamber pacemaker was inserted into the patient’s heart. No further VT occurred during the 3-year follow-up after hospital discharge. CONCLUSION The diagnosis of VT originating from the His bundle is rare and difficult to establish. The results of this study showed VT originating from the His bundle based on a careful evaluation of the electrocardiogram, and the diagnosis was confirmed by an intracardiac electrophysiologic examination.

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Bipolar Radiofrequency Ablation of Ventricular Arrhythmias Originating in the Vicinity of His Bundle

Cited by 21 publications

References 5 publications

Bipolar catheter ablation strategies for outflow tract ventricular arrhythmias refractory to unipolar ablation

Bipolar catheter ablation strategies for outflow tract ventricular arrhythmias refractory to unipolar ablation

Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the vicinity of tricuspid annulus

Ventricular tachycardia originating from the His bundle: A case report

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