AIMS: Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC. METHODS AND RESULTS: Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%). CONCLUSION: These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC.

1st Clinic of Cardiology and Electrotherapy Swietokrzyskie Cardiology Centre Kielce Poland

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

5th Department of Internal Medicine Cardiology Rehabilitation Iuliu Hatieganu University of Medicine and Pharmacy of Cluj Napoca Cluj Napoca Romania

Cardioangiologisches Centrum Bethanien Department Kardiologie Markus Krankenhaus Frankfurt Germany

Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland

Clinic for Electrophysiology Herz und Diabeteszentrum NRW Ruhr Universitaet Bochum Bad Oeynhausen Germany

Clinical Electrophysiology Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA

Clinical Electrophysiology St Joseph's Heart Rhythm Center University of Rzeszów Anny Jagiellonki 17 35 623 Rzeszów Poland

Collegium Medicum Jan Kochanowski University Kielce Poland

Department for Cardiovascular Medicine University Hospital Dubrava Zagreb Croatia

Department of Cardiology Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiology University Hospital Basel Basel Switzerland

Department of Cardiology University Medical Centre of Ljubljana Ljubljana Slovenia

Department of Internal Medicine 2 Cardiology Angiology and Intensive Care Medicine Ordensklinikum Linz Elisabethinen Linz Austria

Department of Internal Medicine 3 Kiel Germany

Department of Internal Medicine Cardiology and Nephrology Hospital Wiener Neustadt Wiener Neustadt Austria

Division of Cardiology Department of Medicine Medical University of Graz Graz Austria

Heart Center Department of Electrophysiology University Hospital Cologne Cologne Germany

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