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Bipolar endo-epicardial RF ablation: Animal feasibility study.

Paweł Derejko1, Izabela Janus2, Piotr Kułakowski3

  • 1Department of Cardiology, Medicover Hospital, Warsaw, Poland; Department of Cardiac Arrhythmias, National Institute of Cardiology, Warsaw, Poland.

Heart Rhythm
|February 9, 2024
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Summary

Bipolar radiofrequency ablation (B-RFA) creates smaller chronic lesions than acute ones. High steam pop incidence during endo-epicardial B-RFA requires careful power management.

Keywords:
3D mappingBipolar ablationEpicardial ablationEpicardial accessLesion dimensionsRF ablationSteam pop

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Area of Science:

  • Cardiovascular Ablation Technologies
  • Cardiac Electrophysiology Research
  • Animal Models in Medical Research

Background:

  • Bipolar radiofrequency ablation (B-RFA) treats arrhythmias resistant to unipolar ablation.
  • Limited research exists on endo-epicardial B-RFA applications.

Purpose of the Study:

  • Evaluate chronic lesions from endo-epicardial B-RFA.
  • Determine optimal settings for endo-epicardial B-RFA in an animal model.

Main Methods:

  • Performed endo-epicardial B-RFA in 7 pigs using 2 electrodes on the left ventricular free wall.
  • Delivered radiofrequency current at 25, 30, 35, 40, and 50 W for 60 seconds.
  • Assessed 31 lesions at 12 weeks post-ablation.

Main Results:

  • Lesion size (7.2–68 mm²) correlated with power, endocardial temperature, and epicardial temperature.
  • Lesion depth (1.9–11 mm) correlated with impedance decrement; 8 lesions were transmural.
  • Steam pops occurred in 20% of applications (30–50 W), with one fatal tamponade at 40 W.

Conclusions:

  • Chronic endo-epicardial B-RFA lesions are smaller and less transmural than acute lesions.
  • High incidence of steam pops observed, even at lower power settings.