Document Detail


Bipolar ablation of the interventricular septum is more efficient at creating a transmural line than sequential unipolar ablation.
MedLine Citation:
PMID:  20449877     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Post infarct ventricular tachycardia (VT) often involves the interventricular septum (IVS) and requires transmural septal ablation. The purpose of this study was to compare the efficacy of bipolar ablation (BIA) versus sequential unipolar ablation (SUA) in creating a transmural ablation line along the IVS scar border. METHODS AND RESULTS: Both ablation strategies were compared in a phantom agar model first and then in 10 post infarct sheep. In the phantom agar model BIA lesions were larger, transmural, and less dependent on catheter alignment and contact compared with SUA. Noncontact mapping was used in the animals to identify the septal scar border and create a 30-mm ablation line. In five animals BIA (50 W) was performed between two irrigated catheters on either side of the IVS, and in five control animals SUA (50 W) was performed, first on the left ventricle (LV) septal scar border and then on the opposing right ventricle (RV) septal surface. Electrical block along ablation lines was confirmed with noncontact mapping. BIA required significantly less ablations (12 + or - 1 vs 29 + or - 7, P = 0.001), ablation time (22 + or - 3 vs 48 + or - 6 minutes, P < 0.001), and energy (58 + or - 7 vs 124 + or - 21 kJ, P < 0.001). At pathological examination all ablation lines in both groups were transmural at the IVS border. BIA endocardial ablation lines (LV + RV) were significantly longer than SUA lines (76 + or - 10 vs 49 + or - 11 mm, P = 0.003). CONCLUSION: BIA of the IVS is highly effective at creating a transmural ablation line, requiring less ablation and creating longer lesions than SUA. BIA ablation may have a role for post infarct VT involving the IVS.
Authors:
Gopal Sivagangabalan; Michael A Barry; Kaimin Huang; Juntang Lu; Jim Pouliopoulos; Stuart P Thomas; David L Ross; Aravinda Thiagalingam; Pramesh Kovoor
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  33     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-26     Citation Subset:  IM    
Affiliation:
Cardiology Department, Westmead Hospital, Sydney, Australia.
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MeSH Terms
Descriptor/Qualifier:
Ablation Techniques / methods*
Agar
Animals
Heart Septum / pathology,  surgery*
Humans
Models, Structural
Myocardial Infarction / surgery
Sheep
Time Factors
Chemical
Reg. No./Substance:
9002-18-0/Agar

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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