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Tan NY, Ladas TP, Christopoulos G, Sugrue AM, van Zyl M, Ladejobi AO, Lodhi FK, Hu TY, Ezzeddine FM, Agboola K, Uecker D, Maor E, Tri JA, Jiang Z, Yasin OZ, DeSimone CV, Killu AM, Asirvatham SJ, Del-Carpio Munoz F. Ventricular nanosecond pulsed electric field delivery using active fixation leads: a proof-of-concept preclinical study. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01268-z. [PMID: 35771400 DOI: 10.1007/s10840-022-01268-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Mid-myocardial ventricular arrhythmias are challenging to treat. Cardiac electroporation via pulsed electric fields (PEFs) offers significant promise. We therefore tested PEF delivery using screw-in pacemaker leads as proof-of-concept. METHODS In 5 canine models, we applied nanosecond PEF (pulse width 300 ns) across the right ventricular (RV) septum using a single lead bipolar configuration (n = 2) and between two leads (n = 3). We recorded electrograms (EGMs) prior to, immediately post, and 5 min after PEF. Cardiac magnetic resonance imaging (cMRI) and histopathology were performed at 2 weeks and 1 month. RESULTS Nanosecond PEF induced minimal extracardiac stimulation and frequent ventricular ectopy that terminated post-treatment; no canines died with PEF delivery. With 1 lead, energy delivery ranged from 0.64 to 7.28 J. Transient ST elevations were seen post-PEF. No myocardial delayed enhancement (MDE) was seen on cMRI. No lesions were noted on the RV septum at autopsy. With 2 leads, energy delivery ranged from 56.3 to 144.9 J. Persistent ST elevations and marked EGM amplitude decreases developed post-PEF. MDE was seen along the septum 2 weeks and 1 month post-PEF. There were discrete fibrotic lesions along the septum; pathology revealed dense connective tissue with < 5% residual cardiomyocytes. CONCLUSIONS Ventricular electroporation is feasible and safe with an active fixation device. Reversible changes were seen with lower energy PEF delivery, whereas durable lesions were created at higher energies. Central illustration: pulsed electric field delivery into ventricular myocardium with active fixation leads.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Thomas P Ladas
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Georgios Christopoulos
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Alan M Sugrue
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Adetola O Ladejobi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Fahad K Lodhi
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Tiffany Y Hu
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Kolade Agboola
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | | | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Jason A Tri
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Zhi Jiang
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Omar Z Yasin
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, 200 1st Street Southwest, Rochester, MN, 55905, USA.
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Weber H, Enders S, Keiditisch E. Percutaneous Nd:YAG laser coagulation of ventricular myocardium in dogs using a special electrode laser catheter. Pacing Clin Electrophysiol 1989; 12:899-910. [PMID: 2472616 DOI: 10.1111/j.1540-8159.1989.tb05026.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A novel catheter system was used for intracardiac electrogram recordings, ventricular pacing and continuous-wave Nd:YAG laser (1,064 nm) irradiation of ventricular myocardium in eight dogs. Radiation at a power of 10 W for 3, 5, and 10 seconds was delivered through a 400 microns optical fiber. Power density was 15 W/mm2. A total of 96 laser injuries (12 per dog) were produced in selected sites in both the right and the left normal canine ventricle. Ventricular arrhythmias were noted during 12 of 96 (12.5%) laser pulses. Programmed electrical stimulation performed during control study immediately (all dogs) at 2 days (two dogs), and 4 months (4 dogs) following the experiments showed no episodes of sustained or nonsustained ventricular tachycardia. Radiation energies up to 50 J (10 W over 5 s) caused focal injuries of homogeneous coagulation/fibrosis localized to the target area, without vaporizing tissue and forming craters. Morphometrically and histologically there was a direct relationship between the energy of radiation delivered, and the extent and severity of the injury produced. The maximum size of lesions measured 7/11 mm (diameter/depth). Using a special catheter system laser coagulation of myocardium can be accomplished percutaneously. This method can create controlled subendocardial injuries without major side effects and appears to overcome most disadvantages of transcatheter high energy direct-current shocks when used as a regular course of procedure in ablation of arrhythmogenic tissue in the heart.
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Affiliation(s)
- H Weber
- Division of Cardiology and Pulmology, Klinikum München-Bogenhausen, F.R. of Germany
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Saksena S, Tarjan PP, Bharati S, Boveja B, Cohen D, Joubert T, Lev M. Low-energy transvenous ablation of the canine atrioventricular conduction system with a suction electrode catheter. Circulation 1987; 76:394-403. [PMID: 3608125 DOI: 10.1161/01.cir.76.2.394] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A single suction electrode catheter was used for His bundle electrogram recording. His bundle pacing, and low-energy (20 or 30 J) His bundle ablation in seven dogs. The suction electrode catheter was actively fixed to the atrial endocardium at the His bundle level. Electrophysiologic studies were performed in the control state, immediately after, and late (greater than 40 days) after His bundle ablation and results were correlated with histologic findings in the conduction system. Unipolar His bundle recording and pacing were successfully performed in all dogs with the suction electrode catheter before and after ablation. Complete heart block developed after a single 20 J shock delivered via the suction electrode catheter in all dogs immediately, but reverted to 1:1 atrioventricular conduction with first-degree atrioventricular block in two dogs in which one or two additional shocks (20 or 30 J) produced complete heart block. Mean ablation energy per shock was 22 +/- 4 J. The mean total delivered energy per dog was 31 +/- 20 J. Late electrophysiologic study in all dogs showed persistent complete heart block in five dogs and paroxysmal second-degree or third-degree atrioventricular block in two dogs. Gross examination of the ablation site showed a white plaque above the medial tricuspid leaflet (1.4 to 2.0 cm long and 0.4 to 0.6 cm wide). Microscopically, fibrosis of the penetrating and branching His bundle was seen in all dogs, with minimal atrioventricular node and atrial involvement. Significant proximal right bundle branch fibrosis was observed in the two dogs receiving one or two additional shocks. We conclude that the suction electrode catheter permits repeated His bundle recording, pacing, and ablation with a single catheter. Permanent and safe low-energy ablation of the canine His bundle is feasible. Focal injury localized to the target area in the conduction system can be obtained.
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