Bipolar ablation’s unique paradigm: Duration and power as respectively distinct primary determinants of transmurality and steam pop formation

Abstract

Background: Bipolar radiofrequency (RF) ablation strategies are increasingly used, mainly to target deep myocardial reentrant circuits responsible for ventricular tachycardia that cannot be extinguished with traditional unipolar RF ablation. Because this strategy is novel, factors that affect lesion geometry and steam pop formation require further investigation. Objective: To assess the effect of contact force, power, and time on the resulting lesion geometry and the risk of steam pop formation during bipolar RF ablation of thick myocardial tissue. Methods: A custom ex vivo bipolar ablation model was used to assess lesion formation. A combination of parallel and perpendicular configurations of ablation catheters was used to create lesions by varying force (20g, 30g, or 40g), power (30 or 40 W), and time (20, 30, 45, or 60 seconds). Lesion dimensions and the incidence of steam pops were recorded and then analyzed with binary logistic regression and multiple linear regression. Results: In bipolar ablation, lesion transmurality was most affected by the amount of time RF energy was applied. Durations longer than 20 seconds resulted in lesions deeper than half the tissue thickness. Steam pop formation was more frequent in thinner tissue, at longer ablation times, and at higher powers. Conclusion: The parameters assessed in this ex vivo model could be used as guidelines for future in vivo work and clinical evaluation of interventricular septal bipolar ablation.

Keywords

• Arrhythmia
• Bipolar ablation
• Cardiac electrophysiologic techniques
• Catheter ablation/methods
• Steam pop