Bipolar Radiofrequency Catheter Ablation for Ventricular Arrhythmias

Abstract

A minority of premature ventricular contractions (PVC) and ventricular tachycardias (VT) have an intramural origin, which represents a challenge for conventional radiofrequency ablation. Bipolar ablation has the potential ability to create deeper and more transmural lesions and has been demonstrated to be optimal treatment in these cases. Bipolar ablation carries a relatively low risk of complications and is effective in eliminating or reducing the burden of ventricular arrhythmias. Despite its utility and efficacy, the clinical use of bipolar ablation is limited, and B-RF technology is still investigational and not widely available. This article reviews the technique of bipolar ablation and all its advantages when applied to specific scenarios.

Keywords: bipolar; catheter ablation; intramural ventricular arrhythmias.

Fig. 1.

Schematic setup of a usual unipolar irrigated radiofrequency ablation system (A) and a bipolar irrigated radiofrequency ablation system (B). In comparison to a unipolar ablation system, no ground pad is used, and a second ablation catheter is attached to the indifferent electrode port (IND) of the radiofrequency generator. ACT, Active electrode; IND, indifferent electrode; RF, radiofrequency generator; IP, irrigation pump; IP2, second irrigation pump; GP, ground pad.

Fig. 2.

Left anterior oblique view of bipolar ablation of a VT originating from the interventricular septum. Both catheters are visualized as ablation catheters and the distance between them is displayed in mm (CARTO 3 system (Biosense Webster, Irvine, CA, USA)).