Bipolar radiofrequency catheter ablation for refractory perimitral flutter: a case report

BMC Cardiovascular Disorders

Case Report

Petr Peichl¹  Kenichiro Yamagata¹  Dan Wichterle¹  Josef Kautzner¹  Robert Čihák¹  Bashar Aldhoon¹ 

[1] Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, 140 21, Prague, Czech Republic;

关键词: Catheter ablation;    Radiofrequency;    Bipolar ablation;    Perimitral flutter;   

DOI  :  10.1186/s12872-015-0132-z

 received in 2015-07-20, accepted in 2015-10-23,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMitral isthmus is often targeted as a part of stepwise approach during radiofrequency ablation for persistent atrial ablation. Acute success rate in achieving the mitral isthmus block is only modest, late reconduction rate is relatively high and, consequently, incomplete lesion may be proarrhythmic. We describe the first-in-man experience with successful MI ablation by bipolar RF energy delivery.Case presentationA 64-year-old caucasian man after two previous ablation procedures for drug resistant atrial fibrillation in recent four years, which included pulmonary vein isolation and linear left atrial lesions, was referred for the treatment of recurrent perimitral flutter. Despite the third attempt to create bidirectional block at the mitral isthmus region, we were not even able to stop the arrhythmia by aggressive unipolar radiofrequency ablation both from the left atrium and coronary sinus, because of deeply embedded slow conducting channel probably around the vein of Marshall. Arrhythmia was finally terminated and the block was achieved by bipolar radiofrequency ablation between two irrigated-tip catheters positioned at the left atrial endocardium and contralaterally inside the coronary sinus.ConclusionBipolar radiofrequency energy delivery can be an option for ablation of perimitral flutter resistant to standard unipolar radiofrequency ablation. This may improve clinical outcome of patients undergoing non-pharmacological treatment for persistent atrial fibrillation. The safety and efficacy of this technique has to be confirmed in future studies.

【 授权许可】

CC BY   
© Yamagata et al. 2015