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Zhang H, Ji X, Zang L, Yan S, Wu X. Process Analysis and Parameter Selection of Cardiomyocyte Electroporation Based on the Finite Element Method. Cardiovasc Eng Technol 2024; 15:22-38. [PMID: 37919538 DOI: 10.1007/s13239-023-00694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Pulsed-field ablation (PFA) has attracted attention for the treatment of atrial fibrillation. This study aimed to further explore the relationship between the transmembrane voltage, pore radius and the intensity and duration of pulsed electric fields, which are closely related to the formation of irreversible electroporation. The different mechanisms of microsecond and nanosecond pulses acting on cardiomyocyte cellular and nuclear membranes were studied. METHODS A 3-D cardiomyocyte model with a nucleus was constructed to simulate the process of electroporation in cells under an electric field. Cell membrane electroporation was used to simulate the effect of different pulse parameters on the process of electroporation. RESULTS Under a single pulse with a field strength of 1 kV/cm and width of 100 μs, the transmembrane potential (TMP) of the cell membrane reached 1.33 V, and the pore density and conductivity increased rapidly. The maximum pore radius of the cell membrane was 43.4 nm, and the electroporation area accounted for 4.6% of the total cell membrane area. The number of pores was positively correlated with the electric field intensity when the cell was exposed to electric fields of 0.5 to 6 kV/cm. Under a nanosecond pulse, the TMP of the nuclear and cell membranes exceeded 1 V after exposure to electric fields with strengths of 4 and 5 kV/cm, respectively. CONCLUSION This study simulated the electroporation process of cardiomyocyte, and provides a basis for the selection of parameters for the application of PFA for application toward arrhythmias.
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Affiliation(s)
- Hao Zhang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China
| | - Xingkai Ji
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China
| | - Lianru Zang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China
| | - Shengjie Yan
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China.
| | - Xiaomei Wu
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, 200438, China.
- Academy for Engineering and Technology, Fudan University, Shanghai, 200433, China.
- Yiwu Research Institute, Fudan University, Yiwu, 322000, China.
- Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai, 200032, China.
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, 200093, China.
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Ji X, Zhang H, Zang L, Yan S, Wu X. The Effect of Discharge Mode on the Distribution of Myocardial Pulsed Electric Field—A Simulation Study for Pulsed Field Ablation of Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9040095. [PMID: 35448071 PMCID: PMC9031694 DOI: 10.3390/jcdd9040095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/05/2023] Open
Abstract
Background: At present, the effects of discharge modes of multielectrode catheters on the distribution of pulsed electric fields have not been completely clarified. Therefore, the control of the distribution of the pulsed electric field by selecting the discharge mode remains one of the key technical problems to be solved. Methods: We constructed a model including myocardium, blood, and a flower catheter. Subsequently, by setting different positive and ground electrodes, we simulated the electric field distribution in the myocardium of four discharge modes (A, B, C, and D) before and after the catheter rotation and analyzed their mechanisms. Results: Modes B, C, and D formed a continuous circumferential ablation lesion without the rotation of the catheter, with depths of 1.6 mm, 2.7 mm, and 0.7 mm, respectively. After the catheter rotation, the four modes could form a continuous circumferential ablation lesion with widths of 10.8 mm, 10.6 mm, 11.8 mm, and 11.5 mm, respectively, and depths of 5.2 mm, 2.7 mm, 4.7 mm, and 4.0 mm, respectively. Conclusions: The discharge mode directly affects the electric field distribution in the myocardium. Our results can help improve PFA procedures and provide enlightenment for the design of the discharge mode with multielectrode catheters.
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Affiliation(s)
- Xingkai Ji
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (X.J.); (H.Z.); (L.Z.)
| | - Hao Zhang
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (X.J.); (H.Z.); (L.Z.)
| | - Lianru Zang
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (X.J.); (H.Z.); (L.Z.)
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (X.J.); (H.Z.); (L.Z.)
- Correspondence: (S.Y.); (X.W.); Tel.: +86-21-6564-3709-801 or +86-0579-85507181 (X.W.)
| | - Xiaomei Wu
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China; (X.J.); (H.Z.); (L.Z.)
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai 200433, China
- Shanghai Engineering Research Centre of Assistive Devices, Shanghai 200433, China
- Yiwu Research Institute, Fudan University, Chengbei Road, Yiwu City 322000, China
- Correspondence: (S.Y.); (X.W.); Tel.: +86-21-6564-3709-801 or +86-0579-85507181 (X.W.)
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Song Y, Zheng J, Fan L. Nonthermal Irreversible Electroporation to the Esophagus: Evaluation of Acute and Long-Term Pathological Effects in a Rabbit Model. J Am Heart Assoc 2021; 10:e020731. [PMID: 34726077 PMCID: PMC8751962 DOI: 10.1161/jaha.120.020731] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Esophageal ulceration and fistula are severe complications of pulmonary vein isolation using thermal ablation. Nonthermal irreversible electroporation (NTIRE) is a promising new technology for pulmonary vein isolation in patients with atrial fibrillation. NTIRE ablation technology has been used to treat atrial fibrillation; however, the effects of NTIRE on esophageal tissue have not been clearly described. Methods and Results A typical NTIRE electrical protocol was directly applied to esophagi in 84 New Zealand rabbits. Finite element modeling and histological analysis with 120 slices were used to analyze electric field intensity distribution and subsequent tissue changes. A parameter combination of 2000 V/cm multiplied by 90 pulses output is determined to be an effective ablation parameters combination. Within 16 weeks after ablation, no obvious lumen stenosis, epithelial erythema, erosion, ulcer, or fistula was observed in the esophageal tissue. NTIRE effectively results in esophageal cell ablation to death, and subsequently, signs of recovery gradually appear: creeping replacement and regeneration of epithelial basal cells, repair and regeneration of muscle cells, structural remodeling of the muscle layer, and finally the restoration of clear anatomical structures in all layers. Conclusions Monophasic, bipolar NTIRE delivered using plate electrodes in a novel esophageal injury model demonstrates no histopathologic changes to the esophagus at 16 weeks. Data of this study suggest that electroporation ablation is a safe modality for pulsed electroporation ablation near the esophagus.
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Affiliation(s)
- Yue Song
- Department of Urology General Hospital of Northern Theater Command Shenyang China
| | - Jingjing Zheng
- Department of Anesthesia General Hospital of Northern Theater Command Shenyang China
| | - Lianhui Fan
- Department of Urology General Hospital of Northern Theater Command Shenyang China
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Kotalczyk A, Ding WY, Gupta D, Wright DJ, Lip GYH. Clinical outcomes following rhythm control for atrial fibrillation: is early better? Expert Rev Cardiovasc Ther 2021; 19:277-287. [PMID: 33715565 DOI: 10.1080/14779072.2021.1902307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF.Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy.Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Koruth JS, Kuroki K, Kawamura I, Stoffregen WC, Dukkipati SR, Neuzil P, Reddy VY. Focal Pulsed Field Ablation for Pulmonary Vein Isolation and Linear Atrial Lesions: A Preclinical Assessment of Safety and Durability. Circ Arrhythm Electrophysiol 2020; 13:e008716. [PMID: 32370542 DOI: 10.1161/circep.120.008716] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus. METHODS Two cohorts of 6 swine were treated with pulsed fields at low dose (PFLD) and high dose (PFHD) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PFLD), 6 mitral (PFHD), and 6 roof lines (radiofrequency+PFHD). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PFHD and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology. RESULTS Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PFLD to 100% with PFHD (P=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PFHD sections had higher transmurality rates than PFLD (98.3% versus 88.1%; P=0.03) despite greater mean thickness (2.5 versus 1.3 mm; P<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PFHD sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections. CONCLUSIONS The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.
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Affiliation(s)
- Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Kenji Kuroki
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.)
| | - Petr Neuzil
- Homolka Hospital, Prague, Czech Republic (P.N., V.Y.R.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (J.S.K., K.K., I.K., S.R.D., V.Y.R.).,Homolka Hospital, Prague, Czech Republic (P.N., V.Y.R.)
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Koruth JS, Kuroki K, Iwasawa J, Batul SA, Turagam MK, Dukkipati SR, Reddy VY. Feasibility, safety, and durability of porcine atrial ablation using a lattice-tip temperature-controlled radiofrequency ablation catheter. J Cardiovasc Electrophysiol 2020; 31:1323-1331. [PMID: 32250501 DOI: 10.1111/jce.14473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using standard radiofrequency (RF) catheters is limited by incomplete contiguity and prolonged procedural times. A novel, 9-mm lattice-tip irrigated RF catheter can create wide lesions rapidly in swine atria. METHODS In five swine, temperature limited (75°C) irrigated RF for 5 seconds/ablation was selected, to isolate seven pulmonary veins (PVs; five right superior and two inferior commons) and create five right atrial lines. After 4 weeks, repeat mapping and additional ablation to create atrial isthmus lesions were performed. The chronic lesions were submitted for histology. This was compared with right superior PVI data using standard 3.5-mm irrigated tip ablation in six swine. RESULTS All targeted PVs (seven of seven, 100%) were acutely isolated. Durable isolation was observed in all six of six PVs treated with 5-second applications, but not in one PV inadvertently treated with 4-second applications. For the durably isolated PVs, the mean lesion count/PV and total RF time/PV was 16.3 ± 5.2 applications and 81.3 ± 25.9 seconds for the right superior and 14.5 ± 0.7 applications and 71.1 ± 5.5 seconds for the inferior common PV. Right atrial linear ablation was performed with a lesion count of 12 ± 2.3 applications and RF times of 59.5 ± 12.5 seconds. Cavotricuspid and mitral isthmus linear ablations were transmural along their entire length. All 53 of 53 (100%) sections were transmural on histology. CONCLUSION Rapid and durable PVI and linear atrial ablation is feasible with this novel 9-mm lattice-tip catheter.
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Affiliation(s)
- Jacob S Koruth
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenji Kuroki
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jin Iwasawa
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Syed A Batul
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohit K Turagam
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas R Dukkipati
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Koruth J, Kuroki K, Iwasawa J, Enomoto Y, Viswanathan R, Brose R, Buck ED, Speltz M, Dukkipati SR, Reddy VY. Preclinical Evaluation of Pulsed Field Ablation: Electrophysiological and Histological Assessment of Thoracic Vein Isolation. Circ Arrhythm Electrophysiol 2019; 12:e007781. [PMID: 31826647 PMCID: PMC6924932 DOI: 10.1161/circep.119.007781] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a uniquely tissue-selective, nonthermal cardiac ablation modality. Delivery parameters such as the electrical waveform composition and device design are critical to PFA's efficacy and safety, particularly tissue specificity. In a series of preclinical studies, we sought to examine the electrophysiological and histological effects of PFA and compare the safety and feasibility of durable pulmonary vein and superior vena cava (SVC) isolation between radiofrequency ablation and PFA waveforms. METHODS A femoral venous approach was used to gain right and left atrial access under general anesthesia in healthy swine. Baseline potentials in right superior pulmonary and inferior common vein and in SVC were assessed. Bipolar PFA was performed with monophasic (PFAMono) and biphasic (PFABi) waveforms in 7 and 7 swine sequentially and irrigated radiofrequency ablation in 3 swine. Vein potentials were then assessed acutely, and at ≈10 weeks; histology was obtained. RESULTS All targeted veins (n=46) were successfully isolated on the first attempt in all cohorts. The PFABi waveform induced significantly less skeletal muscle engagement. Pulmonary vein isolation durability was assessed in 28 veins: including the SVC, durability was significantly higher in the PFABi group (18/18 PFABi, 10/18 PFAMono, 3/6 radiofrequency, P=0.002). Transmurality rates were similar across groups with evidence of nerve damage only with radiofrequency. Pulmonary vein narrowing was noted only in the radiofrequency cohort. The phrenic nerve was spared in all cohorts but at the expense of incomplete SVC encirclement with radiofrequency. CONCLUSIONS In this chronic porcine study, PFA-based pulmonary vein and SVC isolation were safe and efficacious with demonstrable sparing of nerves and venous tissue. This preclinical study provided the scientific basis for the first-in-human endocardial PFA studies.
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Affiliation(s)
- Jacob Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
| | - Kenji Kuroki
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
| | - Jin Iwasawa
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
| | - Yoshinari Enomoto
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
| | | | | | - Eric D. Buck
- Farapulse, Inc, Menlo Park, CA (R.V., R.B., E.D.B.)
| | | | - Srinivas R. Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (J.K., K.K., J.I., Y.E., S.R.D., V.Y.R.)
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