Mid term outcomes of bipolar catheter ablation for ventricular arrhythmias - a single center experience

Abstract Background Ventricular arrhythmias (VA), comprising of premature ventricular contractions (PVC) and ventricular tachycardia (VT), present a significant therapeutic challenge, particularly when arising from anatomically complex regions and prove resistant to conventional ablation methods. Purpose This study evaluates the mid-term outcomes of bipolar ablation of VA in patients presenting to our ablation center. Methods This study analyzed data from a prospective ablation registry, focusing on patients with recurrent, symptomatic ventricular arrhythmias (VA), including both PVC and VT, who underwent bipolar catheter ablation between July 2022 and October 2024. The cohort included patients with idiopathic VAs and those with structural heart disease (SHD). Bipolar ablation was performed using a dedicated bipolar adapter replacing the ground patch with a second catheter as the indifferent electrode. Acute procedural success was defined as the elimination of VA during the procedure, and follow-up outcomes were assessed for recurrence-free survival. Comparisons were made between PVC and VT patients, as well as between patients with idiopathic VA and those with structural heart disease. Results A total of 23 patients were included in the final analysis, of which 15 underwent bipolar ablation for PVC and 8 for VT. No significant baseline differences were observed between the two groups. Acute procedural success was achieved in 87% of cases. One VT patient suffered from LAD occlusion treated with PCI without sequalae due to epicardial ablation and, and one died 6 days after ablation from cardiogenic shock unrelated to the ablation. During follow-up (mean 6 months), a significantly lower event-rate was noted in the PVC group compared to the VT group (14/15 [93%] PVC patients remained recurrence-free vs. 3/7 [43%] VT patients; p=0.021). Additionally, patients with idiopathic VA showed a significant better outcome compared to those with SHD (recurrence-free survival: 7/7 [100%] vs. (9/15 [60%]; p=0.017). Conclusion Bipolar ablation appears to be a safe and effective treatment option for patients with various forms of ventricular arrhythmias, including both PVC and VT. Notably, recurrence-free outcomes were significantly better for PVC patients compared to those with VT, and patients with idiopathic VA showed significantly better results than those with SHD. Given that VT patients often represent a highly symptomatic and difficult-to-treat population for whom few other options remain, bipolar ablation may offer a critical therapeutic alternative in these challenging cases. Future research should focus on validating these results in large-scale, prospective, trials, comparing bipolar ablation with other novel ablation techniques.