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Lv Y, Feng Z, Liu X, Zhang J, Yao C. The Enhancement of Tumor Ablation Effect by the Combination of High-Frequency and Low-Voltage Bipolar Electroporation Pulses. IEEE Trans Biomed Eng 2024; 71:1577-1586. [PMID: 38113160 DOI: 10.1109/tbme.2023.3344153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
The H-FIRE (high-frequency irreversible electroporation) protocol employs high-frequency bipolar pulses (HFBPs) with a width of ∼1 µs for tumor ablation with slight muscle contraction. However, H-FIRE pulses need a higher electric field to generate a sufficient ablation effect, which may cause undesirable thermal damage. OBJECTIVE Recently, combining short high-voltage IRE monopolar pulses with long low-voltage IRE monopolar pulses was shown to enlarge the ablation region. This finding indicates that combining HFBPs with low-voltage bipolar pulses (LVBPs), which are called composited bipolar pulses (CBPs), may enhance the ablation effect. METHODS This study designed a pulse generator by modifying a full-bridge inverter. The cell suspension and 3D tumor mimic experiments (U251 cells) were performed to examine the enhancement of the ablation effect. RESULTS The generator outputs HFBPs with 0-±2.5 kV and LVBPs with 0-±0.3 kV in one period. The pulse parameters are adjustable by programming on a human-computer interface. The cell suspension experiments showed that CBPs could enhance cytotoxicity, as compared to HFBPs with no cell-killing effect. Even at lower electric energy, the cell viability by CBPs was significantly lower than that of the HFBPs protocol. The ablation experiments on the 3D tumor mimic showed that the CBPs could create a larger connected ablation area. In contrast, the HFBPs protocol with a similar dose generated a nonconnected ablation area. CONCLUSION Results indicate that the CBPs protocol can enhance the ablation effect of HFBPs protocol. SIGNIFICANCE This proposed generator that uses the CBPs principle may be a useful tool for tumor ablation.
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Stupan U, Čemažar M, Trotovšek B, Petrič M, Tomažič A, Gašljević G, Ranković B, Seliškar A, Plavec T, Sredenšek J, Plut J, Štukelj M, Lampreht Tratar U, Jesenko T, Nemec Svete A, Serša G, Đokić M. Histologic changes of porcine portal vein anastomosis after electrochemotherapy with bleomycin. Bioelectrochemistry 2023; 154:108509. [PMID: 37459749 DOI: 10.1016/j.bioelechem.2023.108509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 09/16/2023]
Abstract
Electrochemotherapy (ECT1) is used for treatment of unresectable abdominal malignancies. This study aims to show that ECT of porcine portal vein anastomosis is safe and feasible in order to extend the indications for margin attenuation after resection of locally advanced pancreatic carcinoma. No marked differences were found between the control group and ECT treated groups. Electroporation thus caused irreversible damage to the vascular smooth muscle cells in tunica media that could bedue to the narrow irreversible electroporation zone that may occur near the electrodes, or due to vasa vasorum thrombosis in the tunica externa. Based on the absence of vascular complications, and similar histological changes in lienal veinanastomosis, we can conclude that ECT of portal vein anastomosis is safe and feasible.
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Affiliation(s)
- Urban Stupan
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia.
| | - Maja Čemažar
- Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Veterinary Faculty, Gerbičeva ulica 60, SI-1000 Ljubljana, Slovenia
| | - Blaž Trotovšek
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia; University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
| | - Miha Petrič
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia; University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
| | - Aleš Tomažič
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia; University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
| | - Gorana Gašljević
- Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
| | - Branislava Ranković
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia
| | - Alenka Seliškar
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Tanja Plavec
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Jerneja Sredenšek
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Jan Plut
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Marina Štukelj
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | | | - Tanja Jesenko
- Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
| | - Alenka Nemec Svete
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia
| | - Gregor Serša
- Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia; University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 5, SI-1000 Ljubljana, Slovenia
| | - Mihajlo Đokić
- University of Ljubljana, Faculty of Medicine, Korytkova ulica 2, SI-1000 Ljubljana, Slovenia; University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia
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Fang Z, Li X, Yan S, Si P, Ma F, Zhang W, Zhang B, Zhou T, Yang B. A novel polarity configuration for enhancing ablation depth of pulsed field ablation: Design, modeling, and in vivo validation. Med Phys 2023; 50:5364-5374. [PMID: 37493518 DOI: 10.1002/mp.16621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Pulsed field ablation (PFA) has been increasingly used to cut off the delivery of abnormal electrical signals in the treatment of cardiac arrhythmias. A successful cut off requires forming a layer of transmural damage on the heart wall, and this layer depends on the depth of ablation by PFA. PURPOSE This study aims to propose a novel polarity configuration of PFA to increase the ablation depth in the treatment of cardiac arrhythmias. METHOD A novel polarity configuration was designed for a multi-electrode system, where the number of electrodes is greater than two. The polarity configuration in such multi-electrode system is called the paired-electrode interlaced configuration (PIC). The existing configuration called the single-electrode interlaced configuration (SIC) was used to compare with the PIC. To both the SIC and PIC, a full-SIC or a full-PIC is called when all electrodes (anode, cathode) in a catheter is used otherwise partial-SIC or partial-PIC is called. By the comparison between the full-SIC and full-PIC, the benefit of the PIC was exhibited as opposed to the SIC, but an extra ablation step was added in the PIC in order to form a continuous ablation zone. The other comparative study was taken between a partial-PIC and a partial-SIC with the same number of ablation step. In this study, a rabbit model was built by infusing 0.4% saline solution (at 37°C) into the rabbit's abdominal cavity which surrounds the liver. This model was considered as a biometric environment of the heart, namely cardiac-mimetic model (CMM). RESULT The experimental results have shown that the full-PIC is superior to the full-SIC in the ablation depth, specifically in both the maximum (4.14 ± 0.55 mm vs. 3.35 ± 0.26 mm, p < 0.01) and the minimum (3.18 ± 0.29 mm vs. 2.76 ± 0.28 mm, p < 0.05), and in the ablation width, specifically only in the maximum (8.27 ± 0.76 mm vs. 7.09 ± 0.51 mm, p = 0.019) under an identical ablation time (i.e., 5 s). It is noted that the minimum ablation width did not show a significant difference between the full-PIC and full-SIC (specifically, 5.61 ± 0.86 mm vs. 4.67 ± 0.73 mm, p = 0.069). Considering the lethal electric field threshold (LEFT) to be 600 V/cm for liver tissues, the maximum and minimum ablation depth generated by the full-PIC was found larger than that by the full-SIC (3.90 vs. 3.52 mm, and 3.03 vs. 2.48 mm, respectively) in the simulation. Meanwhile, similar experiment results by comparing the partial-PIC and partial-SIC have been obtained, which shows a significant increase in both the maximum ablation depth (4.81 ± 0.87 mm vs. 3.30 ± 0.73 mm, p < 0.001) and the maximum ablation width (8.19 ± 0.85 mm vs. 6.47 ± 1.13 mm, p = 0.001). CONCLUSIONS (1) The electric field in the PIC is concentrated around the pair of electrodes, and the pattern of the field is a significant factor in the energy delivery along the direction of the depth. (2) The increase of the ablation depth can significantly expand the range of the tissue on the heart, where the PFA can apply, and can therefore readily form a layer of transmural damage on the heart wall at positions at which the wall is thicker.
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Affiliation(s)
- Zheng Fang
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Xiaorong Li
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Peng Si
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Fei Ma
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Wenjun Zhang
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Tuo Zhou
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Sarreshtehdari A, Burdio F, López-Alonso B, Lucía Ó, Burdio JM, Villamonte M, Andaluz A, García-Arnas F, Berjano E, Moll X. Preliminary evaluation of the safety and efficacy of glucose solution infusion through the hepatic artery on irreversible electroporation focusing. Sci Rep 2023; 13:7120. [PMID: 37130847 PMCID: PMC10154417 DOI: 10.1038/s41598-023-33487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/13/2023] [Indexed: 05/04/2023] Open
Abstract
Due to electrical features of the tissue, such as impedance, which have a significant impact on irreversible electroporation (IRE) function, the administration of glucose solution 5% (GS5%) through the hepatic artery would focus IRE on scattered liver tumors. By creating a differential impedance between healthy and tumor tissue. This study aimed to determine the effects of the GS5% protocol on healthy liver tissue and its safety. 21 male Athymic nude rats Hsd: RH-Foxn1mu were used in the study. Animals were split into two groups. In group 1, a continuous infusion through the gastroduodenal artery of GS5% was performed to measure the impedance with a dose of 0.008 mL/g for 16 min. In group 2, the animals were divided into two subgroups for infusions of GS5%. Group 2.1, at 0.008 mL/g for 16 min. Group 2.2 at 0.03 mL/g for 4 min. Blood samples were collected after anesthesia has been induced. The second sample, after catheterization of the artery, and the third after the GS5% infusion. All the animals were sacrificed to collect histological samples. The survival rate during the experiment was 100%. A considerable impact on the impedance of the tissue was noticed, on average up to 4.31 times more than the baseline, and no side effects were observed after GS5% infusion. In conclusion, impedance alteration by Glucose solution infusion may focus IRE on tumor tissue and decrease IRE's effects on healthy tissue.
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Affiliation(s)
- Amirhossein Sarreshtehdari
- Department of Experimental and Health Sciences, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Fernando Burdio
- General Surgery Department, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain.
| | - Borja López-Alonso
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - Óscar Lucía
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - José Miguel Burdio
- Department of Electronic Engineering and Communications, University of Zaragoza, 50018, Zaragoza, Spain
| | - María Villamonte
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - A Andaluz
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F García-Arnas
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Percutaneous Ablation of Hepatic Tumors at the Hepatocaval Confluence Using Irreversible Electroporation: A Preliminary Study. Curr Oncol 2022; 29:3950-3961. [PMID: 35735425 PMCID: PMC9221598 DOI: 10.3390/curroncol29060316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Tumors at the hepatocaval confluence are difficult to treat, either surgically or ablatively. Methods: A retrospective longitudinal study on patients ineligible for thermal ablation who underwent computed tomography-guided IRE for hepatic tumors at the hepatocaval confluence was conducted. Factors analyzed included patient and tumor characteristics, IRE procedure details, treatment-related complications, and prognosis. Results: Between 2017 and 2021, 21 patients at our institute received percutaneous IRE. Of the 38 lesions, 21 were at the hepatocaval confluence. Complete ablation was achieved in all cases. Local and distant recurrence was observed in 4.8% (1/21) and 42.6% (9/21) of the ablated tumors, respectively. All postcava remained perfused at follow-up, except for 1 (4.8%) hepatic vein near the lesion found to be temporarily occluded and restored within 1 month. The ratio of the maximum diameter of ablation area at 1, 3, and 6 months post procedure compared to that immediately after IRE was 0.68 (0.50–0.84), 0.49 (0.27–0.61), and 0.38 (0.25–0.59), respectively. Progression-free survival of the patients with recurrence was 121 (range, 25–566) days. Four (19.0%) patients died at the end of follow-up with median overall survival of 451.5 (range, 25–716) days. Conclusions: IRE could be a safe and effective treatment for hepatic tumors at the hepatocaval confluence. This article provides valuable prognostic data; further clinical research is needed for better prognosis.
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