Provocative Cases -> Teaching Case Reports D-PO02 - Poster Session II (ID 47) Poster

D-PO02-056 - Seeing Is Believing: Simultaneous Real Time Force And Temperature Sensing During Bipolar Ablation (ID 183)

Abstract

Background: Bipolar radiofrequency ablation (Bi-RF) can be used to target intramural ventricular tachycardia (VT) substrate, but current Bi-RF configurations cannot monitor real-time information from both active (Act) and ground (Gr) catheters simultaneously.
Objective: We present a case of refractory VT using Bi-RF with simultaneous real-time contact force (CF) and temperature (Temp) monitoring from both catheters.
Results: A 55 year-old man with nonischemic cardiomyopathy (EF 30%) and refractory VT s/p 8 prior ablations (5 RF, including epicardial, 1 alcohol septal, and 1 stereotactic beam radiation) and multiple antiarrhythmic drugs, was referred with recurrent VT for ablation. Mapping localized earliest activation again to the basal septum, with a septal right ventricular (RV) exit (figure, A). Bi-RF was performed using Precision (Abbott) with simultaneous visualization of Act and Gr catheters and electrograms, which has been previously described. In the present case, we used 2 CF sensing catheters (TactiCath), from which real-time CF and Temp could be monitored simultaneously (figure, B & C). Bi-RF using half normal saline irrigant slowed and terminated VT in the earliest activation region. We then modified substrate remaining from prior procedures, with stable Act/Gr CF and Temps monitored during Bi-RF. In follow-up, the patient has had occasional episodes of ATP-treated VT, but dramatic reduction in VT burden, and no ICD shocks.
Conclusion: Simultaneous visualization and real-time CF and temperature monitoring on Act and Gr ablation catheters during Bi-RF is feasible. This configuration may enhance safety and help predict effective lesion formation.
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