Effectiveness and safety of bipolar ablation of heart arrhythmia. A systematic review with meta-analysis
Bibliographic record
Abstract
Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Poland Introduction Bipolar radiofrequency ablation (BFRA) emerged as a viable technique of radiofrequency ablation where the standard unipolar approach (RFA) failed. A number of studies describing BRFA were published recently suggesting high effectiveness and acceptable safety of this technology for ablation of ventricular tachycardia in structural heart disease (SHD VT), premature ventricular contractions (PVC) or atrial flutter (AFL). Purpose We performed a systematic review with meta-analysis of available evidence to assess contemporary evidence on the effectiveness and safety of bipolar ablation of heart arrhythmia. Methods We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 27 August 2022 for prospective and retrospective studies with or without a control group. We also contacted BRFA experts to obtain information on the most up-to-date studies or conference presentations. Case studies and papers describing technical aspects of BRFA rather than clinical outcomes were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Results Out of 1919 records we included 12 studies: one good quality case-control study and 11 low-quality case series without a control group. Studies described 120 patients who received BFRA: mean age 61.9±10.3 years, 81% males, mean ejection fraction 43.2±12.4, SHD 62.6%, ICD/CRT-D 52.2%. Almost all patients were qualified to BRFA due to failure of at least one unipolar RFA. Follow-up period differed between studies and ranged between 1-2 years in most cases. The overall acute effectiveness of BRFA was 88.2% (95%CI 82.5-93.8), I2=6.7%. The overall effectiveness of a first BRFA at the end of the follow-up period was 55% (95%CI 46.2-63.7), I2=7.2%. There was a need for a re-ablation in 21.2% patients (95%CI 11.2-31.2), I2=64%. A subgroup analysis for SHD VT, PVC and AFL yielded similar results. There were 16 serious complications including one surgical intervention and no acute deaths; five patients died during the follow-up, mainly due to heart failure progression. Conclusions Bipolar radiofrequency ablation may be an effective and safe procedure in selected patients who failed at least one unipolar radiofrequency ablation but the quality of the supporting evidence is generally low.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.040 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".