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Askarinejad A, Kohansal E, Sabahizadeh A, Hesami H, Adimi S, Haghjoo M. Pulsed-Field Ablation in Management of Ventricular Tachycardia: A Systematic Review of Case Reports and Clinical Outcomes. Clin Cardiol 2024; 47:e70018. [PMID: 39350646 PMCID: PMC11442986 DOI: 10.1002/clc.70018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 08/01/2024] [Accepted: 09/10/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a cutting-edge technique that employs non-thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo-ablation for treating ventricular tachycardia. METHODS PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed-field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis. RESULTS We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long-term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases. CONCLUSION The absence of complications, high effectiveness, and long-term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.
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Affiliation(s)
- Amir Askarinejad
- Rajaie Cardiovascular Medical and Research InstitueIran University of Medical SciencesTehranIran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research InstitueIran University of Medical SciencesTehranIran
| | | | - Hamed Hesami
- Rajaie Cardiovascular Medical and Research InstitueIran University of Medical SciencesTehranIran
| | - Sara Adimi
- Cardiovascular Epidemiology Research CenterRajaie Cardiovascular Medical and Research InstituteTehranIran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research InstituteIran University of Medical SciencesTehranIran
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Alken FA, Scherschel K, Zhu E, Wafaisade B, Kahle AK, Meyer C. Interactions of contact force, impedance, and power during repeated atrial arrhythmia ablation after previous atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)03323-X. [PMID: 39293497 DOI: 10.1016/j.hrthm.2024.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/26/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Acutely effective repeated radiofrequency catheter ablation (RFCA) after previous atrial fibrillation ablation depends on several parameters, including local impedance (LI), contact force (CF), and power. OBJECTIVE We aimed to investigate the relationship of LI, CF, and power to the LI drop in a repeated atrial RFCA environment. METHODS Consecutive patients undergoing repeated atrial RFCA were studied. High-quality local electrograms were analyzed for morphology changes indicating effective RFCA and associated LI dynamics. The influence of baseline LI, mean CF, and power on the LI drop was analyzed. Investigated power levels included ≤25 W, 30 W, and ≥40 W. RESULTS There were 1390 RFCA points from 48 patients (48% female; median age, 70 years) analyzed; 40.5% of 309 analyzed electrograms showed effective RFCA morphology changes with a higher median LI drop (effective, 19.7 Ω; partially effective, 14.1 Ω; P < .001). CF showed the highest correlation to the LI drop within high baseline LI and when applying ≥40 W (low baseline LI, R = 0.39; intermediate, R = 0.66; high, R = 0.72). Within low baseline LI regions, CF levels showed a lower correlation to the LI drop (≤25 W, R = 0.30; 30 W, R = 0.35; ≥40 W, R = 0.39). A mean CF ≥10 g resulted in elevated LI drops with higher power compared with lower power within all baseline LI tertiles (P < .001 each). CONCLUSION Within high baseline LI regions, CF plays a greater role for the maximum LI drop when higher power is chosen. A mean CF ≥10 g ensures increased LI drops with increasing power levels.
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Affiliation(s)
- Fares-Alexander Alken
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany
| | - Katharina Scherschel
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Medical Faculty, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany
| | - Ernan Zhu
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany
| | - Bahram Wafaisade
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany
| | - Ann-Kathrin Kahle
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Meyer
- Division of Cardiology, cNEP, cardiac Neuro- and Electrophysiology research group, EVK Düsseldorf, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Medical Faculty, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany.
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3
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Ezzeddine FM, Asirvatham SJ, Nguyen DT. Pulsed Field Ablation: A Comprehensive Update. J Clin Med 2024; 13:5191. [PMID: 39274404 PMCID: PMC11396515 DOI: 10.3390/jcm13175191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024] Open
Abstract
One of the recent advancements in the field of cardiac electrophysiology is pulsed field ablation (PFA). PFA is a novel energy modality that does not rely on thermal processes to achieve ablation which, in turn, results in limited collateral damage to surrounding structures. In this review, we discuss the mechanisms, safety, efficacy, and clinical applications of PFA for the management of atrial and ventricular arrhythmias. We also summarize the published pre-clinical and clinical studies regarding this new technology.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
- Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Clinical Anatomy, Mayo Clinic, Rochester, MN 55905, USA
| | - Duy T Nguyen
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Compagnucci P, Dello Russo A, Gasperetti A, Schiavone M, Sehrawat O, Hasegawa K, Mohanty S, Liang JJ, Kapa S, La Fazia VM, Bogun F, Stevenson WG, Tondo C, Siontis KC, Tandri H, Santangeli P, Natale A, Casella M. Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Amyloid Cardiomyopathy: A Multicenter Study. Circ Arrhythm Electrophysiol 2024; 17:e012788. [PMID: 39171384 DOI: 10.1161/circep.124.012788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 07/03/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Sustained ventricular tachycardia (VT) in cardiac amyloidosis is uncommon, and the substrate and outcomes of catheter ablation are not defined. METHODS We included 22 consecutive patients (mean age, 68±10 years; male sex, 91%) with cardiac amyloidosis (ATTR [transthyretin], n=16; light chain, n=6) undergoing catheter ablation for VT/ventricular fibrillation (VF) between 2013 and 2023 in a retrospective, observational, international study. The primary efficacy outcome was recurrent VT/VF during follow-up, while the primary safety end point included major procedure-related adverse events. RESULTS The indication for ablation was drug-refractory VT in 17 patients (77%), and premature ventricular complex-initiated polymorphic VT/VF in 5 patients (23%). Catheter ablation was performed using endocardial (n=17.77%) or endo-epicardial approaches (n=5.23%). Complete endocardial electroanatomical voltage maps of the left and right ventricles were obtained in 17 (77%) and 10 (45%) patients, respectively. Each patient had evidence of low-voltage areas, most commonly involving the interventricular septum (n=16); late potentials were recorded in 16 patients (73%). A median of 1 (1-2) VT was inducible per patient; 12 of the 26 mappable VTs (46%) originated from the interventricular septum. Complete procedural success was achieved in 16 patients (73%), with 4 (18%) major procedure-related adverse events. After a median follow-up of 32 (14-42) months, sustained VT/VF recurrence was observed in 9 patients (41%); survival free from VT/VF recurrence was 56% (95% CI, 36%-86%) at 36-month follow-up, and most patients remained on antiarrhythmic drugs. A significant reduction in per patient implantable cardioverter defibrillator therapies was noted in the 6-month period after ablation (before: 6 [4-9] versus after: 0 [0-0]; P<0.001). In multivariable analysis, complete procedural success was associated with reduced risk of recurrent VT/VF (hazard ratio, 0.002; P=0.034). CONCLUSIONS Catheter ablation can achieve control of recurrent VT/VF in more than half of patients with cardiac amyloidosis, and the reduction in VT/VF burden post-ablation may be relevant for quality of life. Septal substrate and risk of procedure-related complications challenge successful management of patients with cardiac amyloidosis and VT/VF.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy (P.C., A.D.R., M.C.)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy (P.C., A.D.R., M.C.)
- Department of Biomedical Sciences and Public Health (A.D.R., A.G.), Marche Polytechnic University, Ancona, Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health (A.D.R., A.G.), Marche Polytechnic University, Ancona, Italy
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.G.)
| | - Marco Schiavone
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy (M.S., C.T.)
| | - Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.S., S.K., K.C.S.)
| | - Kanae Hasegawa
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., V.M.L.F., A.N.)
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (J.J.L., F.B.)
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.S., S.K., K.C.S.)
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., V.M.L.F., A.N.)
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (J.J.L., F.B.)
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.)
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy (M.S., C.T.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy (C.T.)
| | | | - Harikrishna Tandri
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (K.H., W.G.S., H.T.)
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (S.M., V.M.L.F., A.N.)
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.)
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
- Department of Biomedicine and Prevention, Division of Cardiology, University of Rome Tor Vergata, Italy (A.N.)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy (P.C., A.D.R., M.C.)
- Department of Clinical, Special and Dental Sciences (M.C.), Marche Polytechnic University, Ancona, Italy
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5
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Della Rocca DG, Cespón-Fernández M, Keelani A, Raffa S, Pannone L, Almorad A, Ströker E, Borisov G, Bala G, Sieira J, Vetta G, Alothman O, Sorgente A, Audiat C, Overeinder I, Frommhold M, Del Monte A, La Meir M, Natale A, Chierchia GB, Geller JC, de Asmundis C, Sarkozy A. Focal Pulsed Field Ablation for Premature Ventricular Contractions: A Multicenter Experience. Circ Arrhythm Electrophysiol 2024; 17:e012826. [PMID: 39234745 DOI: 10.1161/circep.124.012826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation. METHODS A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion. RESULTS Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case). CONCLUSIONS PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.
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Affiliation(s)
- Domenico Giovanni Della Rocca
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
| | - María Cespón-Fernández
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Galicia Sur Health Research Institute, Vigo, Spain (M.C.-F.)
| | - Ahmad Keelani
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Santi Raffa
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Luigi Pannone
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Georgi Borisov
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Giampaolo Vetta
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Obaida Alothman
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Charles Audiat
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Markus Frommhold
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Alvise Del Monte
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Belgium (M.L.M.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
- Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy (A.N.)
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
- Faculty of Medicine, Otto-von-Guericke University Magdeburg, Germany (J.C.G.)
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
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6
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Fassini G, Zito E, Bianchini L, Tundo F, Tondo C, Schiavone M. Ventricular tachycardia ablation with pentaspline pulsed field technology in two patients with ischemic cardiomyopathy. J Cardiovasc Electrophysiol 2024. [PMID: 39188042 DOI: 10.1111/jce.16418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Due to its unique features, pulsed field ablation (PFA) could potentially overcome some limitations of current radiofrequency (RF) ventricular tachycardia (VT) ablation. However, data on the use of PFA in this setting are currently scarce. METHODS Two patients with ischemic cardiomyopathy and previously failed RF VT ablations were treated with PFA. RESULTS A total of 18 bipolar applications (case1) and seven bipolar applications (case2) were delivered to the infero-lateral and infero-septal areas (case1) and to the apical lateral left ventricular (LV) wall (case2), placing the catheter adjacent to the LV wall in the flower configuration. A rapid cessation of VT and restoration of sinus rhythm were observed during PFA delivery in both cases. Further applications were delivered to achieve complete elimination of late potentials. In case 1, during the in-hospital stay, ECG monitoring did not show VT recurrences. Six-month follow-up was uneventful, with no VT recurrences at ICD interrogation. In case 2, due to postdischarge VT recurrences, a second RF procedure was scheduled 1 month later. The voltage map performed in sinus rhythm showed a low-voltage zone located at the anterolateral wall, near the previous ablation site. Numerous late potentials were recorded. At the 6-month follow-up, no further VT recurrences were documented after RF redo ablation. CONCLUSION While the speed of application and potential transmural effect can facilitate the ablation of large diseased endocardial areas, early loss of contact due to difficult pentaspline catheter manipulation in the LV could lead to insufficient contact force and, consequently, inadequate energy penetration.
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Affiliation(s)
- Gaetano Fassini
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Elio Zito
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Lorenzo Bianchini
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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7
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Katrapati P, Weiss JP, Baning D, Zawaneh M, Su W, Tung R. Pulsed field ablation for incessant scar-related ventricular tachycardia: First US report. Heart Rhythm 2024; 21:1236-1239. [PMID: 38677358 DOI: 10.1016/j.hrthm.2024.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Praneeth Katrapati
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - J Peter Weiss
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - David Baning
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Michael Zawaneh
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Wilber Su
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Roderick Tung
- Banner-University Medical Center Phoenix and The University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
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8
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Zhang Z, Xiao Y, Wang C, Zhou J, Lin Q, Tu T, Wu K, Huang Y, Zhang Z, Liu C, Liu Q. Pulsed field ablation: A promising approach for ventricular tachycardia ablation. Int J Cardiol 2024; 407:131985. [PMID: 38513736 DOI: 10.1016/j.ijcard.2024.131985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
Radiofrequency ablation (RFA) has been a central therapeutic strategy for ventricular tachycardia (VT). However, concerns about its long-term effectiveness and complications have arisen. Pulsed field ablation (PFA), characterized by its nonthermal, highly tissue-selective ablation technique, has emerged as a promising alternative. This comprehensive review delves into the potential advantages and opportunities presented by PFA in the realm of VT, drawing insights from both animal experimentation and clinical case studies. PFA shows promise in generating superior lesions within scarred myocardial tissue, and its inherent repetition dependency holds the potential to enhance therapeutic outcomes. Clinical cases underscore the promise of PFA for VT ablation. Despite its promising applications, challenges such as catheter maneuverability and proarrhythmic effects require further investigation. Large-scale, long-term studies are essential to establish the suitability of PFA for VT treatment.
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Affiliation(s)
- Zixi Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Cancan Wang
- Department of Metabolic Endocrinology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China
| | - Jiabao Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Tao Tu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Keke Wu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Yunying Huang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Zeying Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Chan Liu
- Department of International Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
| | - Qiming Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, People's Republic of China.
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9
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Erhard N, Englert F, Prommersberger S, Popa M, Bourier F, Reents T, Kraft H, Martinez AT, Syväri J, Tydecks M, Abdiu E, Koops E, Reiter T, Telishevska M, Lengauer S, Hessling G, Deisenhofer I, Bahlke F. Focal pulsed field ablation in complex atrial tachycardia: First clinical experience and 1-year outcome. Heart Rhythm 2024:S1547-5271(24)02905-9. [PMID: 39019385 DOI: 10.1016/j.hrthm.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/13/2024] [Accepted: 07/02/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Pulsed field ablation (PFA) has become increasingly important in the treatment of cardiac arrhythmias. In addition to single-shot devices mainly used for pulmonary vein isolation, focal PFA may provide a treatment option that increases the versatility of the technique. OBJECTIVE The purpose of this study was to provide data on feasibility, safety, and long-term outcome of focal PFA for ablation of complex atrial tachycardia (AT). METHODS All consecutive patients (n = 34) with complex AT treated at our department between 2022 and 2023 with a focal PFA system (CENTAURI™, Galvanize Therapeutics) were included. The majority of patients (32/34) previously had undergone at least 1 radiofrequency ablation. Established contact force-sensing catheters were used for PFA application in combination with a PFA generator. Pulsed electric field trains were conducted in a R-wave triggered manner. RESULTS Acute procedural success was accomplished in all patients. PFA included creation of 51 linear lesions and (re)isolation of 12 pulmonary veins. Mean procedural duration was 102.7 ± 30.3 minutes, with left atrial dwell time of 75.0 ± 24.7 minutes. Mean fluoroscopy duration was 8.7 ± 5.3 minutes. No complications occurred. After mean follow-up of 340.9 ± 130.1 days, recurrence of any AT occurred in 15 patients (44.1%). During 9 reablations, 3 gaps in previously created linear lesions were detected; the majority of recurrences (n = 6) were not related to previous PFA lesion creation. CONCLUSION Focal PFA of complex AT substrates was safe and efficient. Acute procedural success was 100%. After 1 year, the majority of patients were in sinus rhythm. A minority of recurrences was caused by insufficient PFA lesion creation.
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Affiliation(s)
- Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Simon Prommersberger
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Hannah Kraft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alex Tunsch Martinez
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Jan Syväri
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Madeleine Tydecks
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Edison Abdiu
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Eva Koops
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Theresa Reiter
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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10
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Peichl P, Bulava A, Wichterle D, Schlosser F, Stojadinović P, Borišincová E, Štiavnický P, Hašková J, Kautzner J. Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience. Europace 2024; 26:euae192. [PMID: 38988256 PMCID: PMC11264298 DOI: 10.1093/europace/euae192] [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: 05/30/2024] [Accepted: 07/06/2024] [Indexed: 07/12/2024] Open
Abstract
AIMS A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF. METHODS AND RESULTS The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA. CONCLUSION Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
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Affiliation(s)
- Petr Peichl
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Alan Bulava
- České Budějovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice, České Budějovice, Czechia
| | - Dan Wichterle
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Filip Schlosser
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Predrag Stojadinović
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Eva Borišincová
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Peter Štiavnický
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Jana Hašková
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Josef Kautzner
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
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11
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Nies M, Watanabe K, Kawamura I, Wang BJ, Litt J, Turovskiy R, Danitz DJ, Uecker DR, Linder KE, Maejima Y, Sasano T, Reddy VY, Koruth JS. Ablating Myocardium Using Nanosecond Pulsed Electric Fields: Preclinical Assessment of Feasibility, Safety, and Durability. Circ Arrhythm Electrophysiol 2024; 17:e012854. [PMID: 38758741 PMCID: PMC11254255 DOI: 10.1161/circep.124.012854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/17/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Unlike conventional microsecond pulsed electrical fields that primarily target the cell membranes, nanosecond pulses are thought to primarily electroporate intracellular organelles. We conducted a comprehensive preclinical assessment of catheter-based endocardial nanosecond pulsed field ablation in swine. METHODS A novel endocardial nanosecond pulsed field ablation system was evaluated in a total of 25 swine. Using either a low-dose (5-second duration) or high-dose (15-second duration) strategy, thoracic veins and discrete atrial and ventricular sites were ablated. Predetermined survival periods were <1 (n=1), ≈2 (n=7), ≈7 (n=6), 14 (n=2), or ≈28 (n=9) days, and venous isolation was assessed before euthanasia. Safety assessments included evaluation of esophageal effects, phrenic nerve function, and changes in venous caliber. All tissues were subject to careful gross pathological and histopathologic examination. RESULTS All (100%) veins (13 low-dose, 34 high-dose) were acutely isolated, and all reassessed veins (6 low-dose, 15 high-dose) were durably isolated. All examined vein lesions (10 low-dose, 22 high-dose) were transmural. Vein diameters (n=15) were not significantly changed. Of the animals assessed for phrenic palsy (n=9), 3 (33%) demonstrated only transient palsy. There were no differences between dosing strategies. Thirteen mitral isthmus lesions were analyzed, and all 13 (100%) were transmural (depth, 6.4±0.4 mm). Ventricular lesions were 14.7±4.5 mm wide and 7.1±1.3 mm deep, with high-dose lesions deeper than low-dose (7.9±1.2 versus 6.2±0.8 mm; P=0.007). The esophagus revealed nontransmural adventitial surface lesions in 5 of 5 (100%) animals euthanized early (2 days) post-ablation. In the 10 animals euthanized later (14-28 days), all animals demonstrated significant esophageal healing-8 with complete resolution, and 2 with only trace fibrosis. CONCLUSIONS A novel, endocardial nanosecond pulsed field ablation system provides acute and durable venous isolation and linear lesions. Transient phrenic injury and nontransmural esophageal lesions can occur with worst-case assessments suggesting limits to pulsed field ablation tissue selectivity and the need for dedicated assessments during clinical studies.
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Affiliation(s)
- Moritz Nies
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Germany (M.N.)
| | - Keita Watanabe
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
| | - Bingyan J. Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York (B.J.W.)
| | - Jeffrey Litt
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - Roman Turovskiy
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - David J. Danitz
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - Darrin R. Uecker
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | | | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers and New Jersey Medical School, Newark (Y.M.)
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
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12
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Krause U, Bergau L, Zabel M, Schneider HE, Müller MJ, Paul T. Pulsed Field Ablation of Atrial Fibrillation and Atrial Tachycardia in Adult Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2024; 17:e012698. [PMID: 38651354 DOI: 10.1161/circep.123.012698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology (U.K., H.E.S., M.J.M., T.P.), University Medical Center, Georg-August-University Göttingen, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center (L.B., M.Z.), University Medical Center, Georg-August-University Göttingen, Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center (L.B., M.Z.), University Medical Center, Georg-August-University Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology (U.K., H.E.S., M.J.M., T.P.), University Medical Center, Georg-August-University Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology (U.K., H.E.S., M.J.M., T.P.), University Medical Center, Georg-August-University Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology (U.K., H.E.S., M.J.M., T.P.), University Medical Center, Georg-August-University Göttingen, Germany
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13
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Compagnucci P, Valeri Y, Conti S, Volpato G, Cipolletta L, Parisi Q, D'Angelo L, Campanelli F, Carboni L, Sgarito G, Natale A, Casella M, Dello Russo A. Technological advances in ventricular tachycardia catheter ablation: the relentless quest for novel solutions to old problems. J Interv Card Electrophysiol 2024; 67:855-864. [PMID: 38087147 DOI: 10.1007/s10840-023-01705-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 06/12/2024]
Abstract
BACKGROUND Several novel technologies allowing catheter ablation (CA) with a favorable safety/efficacy profile have been recently developed, but not yet extensively clinically tested in the setting of ventricular tachycardia CA. METHODS In this technical report, we overview technical aspects and preclinical/clinical information concerning the application of three novel CA technologies in the ventricular milieu: a pulsed field ablation (PFA) generator (CENTAURI™, Galaxy Medical) to be used with linear, contact force-sensing radiofrequency ablation catheters; a contact force-sensing radiofrequency ablation catheter equipped with six thermocouples and three microelectrodes (QDOT Micro™, Biosense-Webster), allowing high-resolution mapping and temperature-controlled CA; and a flexible and mesh-shaped irrigation tip, contact force-sensing radiofrequency ablation catheter (Tactiflex, Abbott). We also report three challenging VT cases in which CA was performed using these technologies. RESULTS The CENTAURI system was used with the Tacticath™ (Abbott) ablation catheter to perform ventricular PFA in a patient with advanced heart failure, electrical storm, and a deep intramural septal substrate. Microelectrode mapping using QDOT Micro™ helped to refine substrate assessment in a VT patient with congenitally corrected transposition of the great arteries, and allowed the identification of the critical components of the VT circuit, which were successfully ablated. Tactiflex™ was used in two challenging CA cases (one endocardial and one epicardial), allowing acute and mid-term control of VT episodes without adverse events. CONCLUSION The ideation and development of novel technologies initially intended to treat atrial arrhythmias and successfully implemented in the ventricular milieu is contributing to the progressive improvement in the clinical benefits derived from VT CA, making this procedure key for successful management of increasingly complex patients.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy.
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
| | - Sergio Conti
- Department of Cardiology, Electrophysiology Unit, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Leonardo D'Angelo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
| | - Francesca Campanelli
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
| | - Laura Carboni
- Cardiac Surgery Anesthesia and Critical Care Unit, University Hospital "Ospedali Riuniti,", Ancona, Italy
| | - Giuseppe Sgarito
- Department of Cardiology, Electrophysiology Unit, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Andrea Natale
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, USA
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy
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14
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Nies M, Watanabe K, Kawamura I, Santos-Gallego CG, Reddy VY, Koruth JS. Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall. Circ Arrhythm Electrophysiol 2024; 17:e012734. [PMID: 38753535 PMCID: PMC11186713 DOI: 10.1161/circep.124.012734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue. METHODS A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall. RESULTS (1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions. CONCLUSIONS This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.
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Affiliation(s)
- Moritz Nies
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.)
| | - Keita Watanabe
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY (C.G.S.-G.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
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15
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Falzone PV, Vazquez-Calvo S, Roca-Luque I. Catheter Ablation of Ventricular Tachycardia in Ischemic Heart Disease: What Is Known and New Perspectives. Curr Heart Fail Rep 2024; 21:174-185. [PMID: 38536648 DOI: 10.1007/s11897-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to evaluate current evidence regarding ventricular tachycardia ablation in patients with ischemic heart disease and explore novel approaches currently developing to improve procedural and long-term outcomes. RECENT FINDINGS Recently published trials (PARTITA, PAUSE-SCD, and SURVIVE-VT) have demonstrated the prognostic benefit of prophylactic ventricular tachycardia ablation compared to current clinical practice. Advanced cardiac imaging provides a valuable pre-procedural evaluation of the arrhythmogenic substrate, identifying ablation targets non-invasively. Advanced cardiac mapping techniques allow to better characterize arrhythmogenic substrate during ablation procedure. Emerging technologies like pulsed field ablation and ultra-low temperature cryoablation show promise in ventricular tachycardia ablation. Advancements in mapping techniques, ablation technologies, and pre-procedural cardiac imaging offer promise for improving ventricular tachycardia ablation outcomes in ischemic heart disease.
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Affiliation(s)
- Pasquale Valerio Falzone
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Vazquez-Calvo
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Chang R, Luo D, He W, Tang W, Chen J, Li J, Liu M, Zhang X, Chen X, Su C, Jiang J, Long M, Wang L. A novel method for septal reduction therapy by three-dimensional guided transvenous intraseptal pulsed-field ablation. Heart Rhythm 2024; 21:258-267. [PMID: 38008368 DOI: 10.1016/j.hrthm.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a nonthermal method for achieving selective cell death with little inflammation response. However, there are no reports of PFA for septal reduction therapy (SRT). OBJECTIVE The purpose of this study was to investigate the effectiveness and safety of PFA for SRT. METHODS A novel transvenous intraseptal PFA method with 3-dimensional (3D) guidance was introduced in Yorkshire pigs. Electrocardiographic parameters, transthoracic echocardiography, and histopathology were used to evaluated. RESULTS The maximum injury diameter of intramyocardial PFA increased with electric field intensity. After PFA, bipolar electrogram amplitude and pacing threshold measured by the PFA electrodes significantly decreased (F = 6.945, P = .007) or increased (F = 5.842, P = .024), respectively. In the ablated septal region, motion amplitude and systolic wall thickening rate significantly decreased and remained at low levels (motion amplitude: F = 20.793, P = .000; systolic wall thickening rate: F = 14.343, P = .000); however, septal thickness did not significantly change after PFA (F = 1.503, P = .248). Histologic examination showed specific cardiomyocyte death with gradually increased hyperchromatic cytoplasm and nuclear pyknosis, without obvious inflammatory cell infiltration in acute phase. TUNEL stain for fragmented DNA showed extensively positive in the ablation region 24 hours after PFA. During PFA, no sustained ventricular arrhythmia or atrioventricular conduction block occurred. CONCLUSION A novel intraseptal PFA method with 3D guidance was described. Intraseptal PFA resulted in effective myocardial injury and local hypokinesis without significant acute edema. Histologic examination showed widely programmed cardiomyocyte death with little inflammatory cell infiltration.
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Affiliation(s)
- Rongxuan Chang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Duan Luo
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Tang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Jian Chen
- Department of Cardiac Surgery, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jie Li
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Xiaoyu Zhang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Xumiao Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Chen Su
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Jingzhou Jiang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Ming Long
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China.
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China.
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Du Y, Ma S, Yue P, Xu Y, Wen Y, Ji M, He L, Liao D. Comparing the effects of pulsed and radiofrequency catheter ablation on quality of life, anxiety, and depression of patients with paroxysmal supraventricular tachycardia: a single-center, randomized, single-blind, standard-controlled trial. Trials 2024; 25:146. [PMID: 38402192 PMCID: PMC10893749 DOI: 10.1186/s13063-024-07971-8] [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: 06/25/2023] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) may lead to decreased quality of life (QOL) and increased anxiety and depression in patients with paroxysmal supraventricular tachycardia (PSVT), possibly due to the lack of selectivity of the ablation tissue and the long ablation time. In recent years, pulsed field ablation (PFA) has been used for the first time in China to treat PSVT patients because of its ability to ablate abnormal tissue sites in a precise and transient manner. This study was conducted to compare the effects of PFA and RFCA on QOL and psychological symptoms of PSVT patients. METHODS We have designed a single-center, randomized, single-blind, standard-controlled trial. A total of 50 participants who met the eligibility criteria would be randomly allocated into the PFA group or RFCA group in a 1:1 ratio. All participants were assessed using the 36-Item Short-Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS) at pre-procedure (T0), post-procedure (T1), and 3 months post-procedure (T2). The SPSS 21.0 software was used to analyze the data through Wilcoxon and Fisher's exact tests and repeated measures ANOVA. RESULTS Twenty-five in the PFA group and 24 in the RFCA group completed the trial. SF-36: (1) Between-group comparison: At T1, PFA group had significantly higher SF-36 scores on physiological function (PF) and general health (GH) than RFCA group, with a treatment difference of 5.61 points and 18.51 points(P < 0.05). (2) Within-group comparison: We found that in the PFA and RFCA groups, T2 showed significant improvement in the remaining 6 subscales of the SF-36 scale compared to T1 and T0 (P < 0.05), except for body pain (BP) and social function (SF) scores. HADS: (1) Between-group comparison: no significant difference (P > 0.05). (2) Within-group comparison: The HADS scores of the PFA and RFCA groups were statistically significant at T2 compared to T0 and T1 (P < 0.05). CONCLUSIONS Our study provided new and meaningful evidence that PFA was effective in significantly improving QOL and decreasing anxiety and depression in PFA patients. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200060272.
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Affiliation(s)
- Ying Du
- Department of Orthopedic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Trauma Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Shanshan Ma
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Pan Yue
- Department of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Xu
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ya Wen
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Mingzhu Ji
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lingxiao He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Trauma Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Dengbin Liao
- Department of Orthopedic Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
- Trauma Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
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Chinyere IR, Mori S, Hutchinson MD. Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation. VESSEL PLUS 2024; 8:7. [PMID: 38646143 PMCID: PMC11027649 DOI: 10.20517/2574-1209.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA's effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.
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Affiliation(s)
- Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Mathew D. Hutchinson
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
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19
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Repp ML, Chinyere IR. Opportunities and Challenges in Catheter-Based Irreversible Electroporation for Ventricular Tachycardia. PATHOPHYSIOLOGY 2024; 31:32-43. [PMID: 38251047 PMCID: PMC10801500 DOI: 10.3390/pathophysiology31010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The use of catheter-based irreversible electroporation in clinical cardiac laboratories, termed pulsed-field ablation (PFA), is gaining international momentum among cardiac electrophysiology proceduralists for the non-thermal management of both atrial and ventricular tachyrhythmogenic substrates. One area of potential application for PFA is in the mitigation of ventricular tachycardia (VT) risk in the setting of ischemia-mediated myocardial fibrosis, as evidenced by recently published clinical case reports. The efficacy of tissue electroporation has been documented in other branches of science and medicine; however, ventricular PFA's potential advantages and pitfalls are less understood. This comprehensive review will briefly summarize the pathophysiological mechanisms underlying VT and then summarize the pre-clinical and adult clinical data published to date on PFA's effectiveness in treating monomorphic VT. These data will be contrasted with the effectiveness ascribed to thermal cardiac ablation modalities to treat VT, namely radiofrequency energy and liquid nitrogen-based cryoablation.
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Affiliation(s)
| | - Ikeotunye Royal Chinyere
- Department of Medecine, Banner University Medicine, Tucson, AZ 85724, USA
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Room 6154, Tucson, AZ 85724, USA
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20
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Aryana A, Hata C, de la Rama A, Nguyen K, Panescu D. A novel pulsed field ablation system using linear and spiral ablation catheters can create large and durable endocardial and epicardial ventricular lesions in vivo. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01714-6. [PMID: 38157151 DOI: 10.1007/s10840-023-01714-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We investigated the preclinical safety and efficacy of ventricular pulsed field ablation (PFA) using a family of novel, 6-/8-Fr, linear, and spiral PFA/mapping catheters (CRC EP, Inc). METHODS QRS-gated, bipolar PFA (>2.0 kV) was performed in 10 healthy swine. Altogether, 20 endocardial and epicardial right and left ventricular applications were delivered. The catheters were inserted through an 8.5-Fr steerable introducer. The intensity of skeletal muscle activation was quantified using an accelerometer. Lesions were assessed by pre- versus post-PFA electrogram analysis, pacing threshold, 3D voltage mapping, necropsy, and histology. The swine rete mirabile, liver and kidneys were examined for embolic events. RESULTS All applications were single-shot (56 ± 18 s) without catheter repositioning. Minimal microbubbling was observed without significant skeletal muscle stimulation (mean acceleration 0.05 m/s2) or ventricular tachyarrhythmias. There was significant reduction in post- versus pre-PFA electrogram amplitude (0.5 ± 0.2 mV versus 3.2 ± 0.9 mV, P < 0.001) with a marked increase in pacing threshold (>20 mA versus 7.5 ± 2.9 mA, P < 0.001). All lesions were large and durable up to 28 days, measuring 32 ± 5 mm (length), 27 ± 8 mm (width), and 8 ± 3 mm (depth) using the spiral catheters and 43 ± 1 mm (length), 7 ± 1 mm (width), and 8 ± 1 mm (depth) using the linear catheters. Despite higher waveform voltages and prolonged applications, no thermal effects were detected at necropsy/histology. Moreover, gross and microscopic examinations revealed no evidence of thromboembolism, vascular or collateral injury. CONCLUSIONS A novel, QRS-gated PFA system using linear and spiral PFA catheters is capable of creating large and durable ventricular lesions in vivo without significant microbubbling, ventricular arrhythmias or thromboembolism.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
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21
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Pérez JJ, González-Suárez A. How intramyocardial fat can alter the electric field distribution during Pulsed Field Ablation (PFA): Qualitative findings from computer modeling. PLoS One 2023; 18:e0287614. [PMID: 37917621 PMCID: PMC10621855 DOI: 10.1371/journal.pone.0287614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 11/04/2023] Open
Abstract
Even though the preliminary experimental data suggests that cardiac Pulsed Field Ablation (PFA) could be superior to radiofrequency ablation (RFA) in terms of being able to ablate the viable myocardium separated from the catheter by collagen and fat, as yet there is no formal physical-based analysis that describes the process by which fat can affect the electric field distribution. Our objective was thus to determine the electrical impact of intramyocardial fat during PFA by means of computer modeling. Computer models were built considering a PFA 3.5-mm blunt-tip catheter in contact with a 7-mm ventricular wall (with and without a scar) and a 2-mm epicardial fat layer. High voltage was set to obtain delivered currents of 19, 22 and 25 A. An electric field value of 1000 V/cm was considered as the lethal threshold. We found that the presence of fibrotic tissue in the scar seems to have a similar impact on the electric field distribution and lesion size to that of healthy myocardium only. However, intramyocardial fat considerably alters the electrical field distribution and the resulting lesion shape. The electric field tends to peak in zones with fat, even away from the ablation electrode, so that 'cold points' (i.e. low electric fields) appear around the fat at the current entry and exit points, while 'hot points' (high electric fields) occur in the lateral areas of the fat zones. The results show that intramyocardial fat can alter the electric field distribution and lesion size during PFA due to its much lower electrical conductivity than that of myocardium and fibrotic tissue.
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Affiliation(s)
- Juan J. Pérez
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Translational Medical Device Lab, School of Engineering, University of Galway, Galway, Ireland
- Universidad Internacional de Valencia—VIU, Valencia, Spain
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22
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Adragão P, Matos D, Carmo P, Costa FM, Ramos S. Pulsed-field ablation vs radiofrequency ablation for ventricular tachycardia: First in-human case of histologic lesion analysis. Heart Rhythm 2023; 20:1395-1398. [PMID: 37488032 DOI: 10.1016/j.hrthm.2023.07.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Pedro Adragão
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Daniel Matos
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal.
| | - Pedro Carmo
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Francisco Moscoso Costa
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Sância Ramos
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
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Marashly Q, Najjar SN, Hahn J, Rector GJ, Khawaja M, Chelu MG. Innovations in ventricular tachycardia ablation. J Interv Card Electrophysiol 2023; 66:1499-1518. [PMID: 35879516 DOI: 10.1007/s10840-022-01311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.
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Affiliation(s)
- Qussay Marashly
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Salim N Najjar
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Joshua Hahn
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Graham J Rector
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Muzamil Khawaja
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, USA.
- Texas Heart Institute, Houston, USA.
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24
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Martin CA, Zaw MT, Jackson N, Morris D, Costanzo P. First worldwide use of pulsed-field ablation for ventricular tachycardia ablation via a retrograde approach. J Cardiovasc Electrophysiol 2023; 34:1772-1775. [PMID: 37431271 DOI: 10.1111/jce.16002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION We present the first worldwide use of pulsed-field ablation (PFA) for ventricular tachycardia (VT) ablation via a retrograde approach. METHODS The patient had previously failed conventional ablation of an intramural circuit underneath the aortic valve. The same VT circuit was inducible during the procedure. The Farawave PFA catheter and Faradrive sheath were used to deliver PFA applications. RESULTS Post ablation mapping demonstrated scar homogenization. There was no evidence of coronary spasm during PFA applications and no other complications occurred. VT was non-inducible post ablation and the patient has remained free of arrhythmia at follow-up. CONCLUSION PFA for VT via a retrograde approach is feasible and effective.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital, Cambridge, UK
- University of Cambridge, Cambridge, UK
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25
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Kos B, Mattison L, Ramirez D, Cindrič H, Sigg DC, Iaizzo PA, Stewart MT, Miklavčič D. Determination of lethal electric field threshold for pulsed field ablation in ex vivo perfused porcine and human hearts. Front Cardiovasc Med 2023; 10:1160231. [PMID: 37424913 PMCID: PMC10326317 DOI: 10.3389/fcvm.2023.1160231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Pulsed field ablation is an emerging modality for catheter-based cardiac ablation. The main mechanism of action is irreversible electroporation (IRE), a threshold-based phenomenon in which cells die after exposure to intense pulsed electric fields. Lethal electric field threshold for IRE is a tissue property that determines treatment feasibility and enables the development of new devices and therapeutic applications, but it is greatly dependent on the number of pulses and their duration. Methods In the study, lesions were generated by applying IRE in porcine and human left ventricles using a pair of parallel needle electrodes at different voltages (500-1500 V) and two different pulse waveforms: a proprietary biphasic waveform (Medtronic) and monophasic 48 × 100 μs pulses. The lethal electric field threshold, anisotropy ratio, and conductivity increase by electroporation were determined by numerical modeling, comparing the model outputs with segmented lesion images. Results The median threshold was 535 V/cm in porcine ((N = 51 lesions in n = 6 hearts) and 416 V/cm in the human donor hearts ((N = 21 lesions in n = 3 hearts) for the biphasic waveform. The median threshold value was 368 V/cm in porcine hearts ((N = 35 lesions in n = 9 hearts) cm for 48 × 100 μs pulses. Discussion The values obtained are compared with an extensive literature review of published lethal electric field thresholds in other tissues and were found to be lower than most other tissues, except for skeletal muscle. These findings, albeit preliminary, from a limited number of hearts suggest that treatments in humans with parameters optimized in pigs should result in equal or greater lesions.
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Affiliation(s)
- Bor Kos
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Lars Mattison
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - David Ramirez
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Helena Cindrič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel C. Sigg
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - Paul A. Iaizzo
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Mark T. Stewart
- Cardiac Ablation Solutions, Medtronic, Inc., Minneapolis, MN, United States
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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Alkukhun L, Sandhu U, Hodovan J, Zhao Y, Chiang K, Castellvi Q, Stenzel P, Woltjer R, Li X, Barajas RF, Nazer B. Multi-modality imaging assessment of microbubbles and cerebral emboli in left ventricular pulsed field ablation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01529-5. [PMID: 37188871 DOI: 10.1007/s10840-023-01529-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/15/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) may have a superior safety profile compared to other technologies, but it has the potential to cause gaseous microbubbles (MB), which may be associated with cerebral emboli. Limited relative safety data has been published regarding PFA in the left ventricle (LV). METHODS Healthy and chronic myocardial infarction (MI) swine underwent PFA (monopolar, biphasic, 25 Amps) in the LV using an irrigated focal catheter under intra-cardiac echocardiography (ICE) guidance for MB monitoring. Two control swine received air MBs through the lumen of the ablation catheter. Swine underwent brain MRI before and after PFA (or control air MB injection). Gross pathology and histology of brains with abnormal MRI findings were performed. RESULTS Four healthy and 5 chronic MI swine underwent 124 left ventricular PFA applications. No PFA-related MB formation was noted on ICE. Both control swine developed multiple acute emboli in the thalamus and caudate on DWI, ADC, and FLAIR brain MRI images in response to air MB injection. Of the 9 PFA swine, there were no abnormalities on ADC or FLAIR images. There was one hyperintense focus in the left putamen on the DWI trace image, but the absence of ADC or FLAIR affirmation suggested it was artifact. Gross pathology and histopathology of this region did not detect any abnormalities. CONCLUSIONS Focal monopolar biphasic PFA of both healthy and chronically infarcted left ventricular myocardium does not generate any MB or cerebral emboli observable on ICE and brain MRI.
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Affiliation(s)
- Laith Alkukhun
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 9723, USA
| | - Uday Sandhu
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 9723, USA
| | - James Hodovan
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 9723, USA
| | - Yan Zhao
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 9723, USA
| | | | | | - Peter Stenzel
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Randy Woltjer
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Ramon F Barajas
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
- Translational Oncology Program, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 9723, USA.
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Scuderi M, Dermol-Černe J, Batista Napotnik T, Chaigne S, Bernus O, Benoist D, Sigg DC, Rems L, Miklavčič D. Characterization of Experimentally Observed Complex Interplay between Pulse Duration, Electrical Field Strength, and Cell Orientation on Electroporation Outcome Using a Time-Dependent Nonlinear Numerical Model. Biomolecules 2023; 13:727. [PMID: 37238597 PMCID: PMC10216437 DOI: 10.3390/biom13050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Electroporation is a biophysical phenomenon involving an increase in cell membrane permeability to molecules after a high-pulsed electric field is applied to the tissue. Currently, electroporation is being developed for non-thermal ablation of cardiac tissue to treat arrhythmias. Cardiomyocytes have been shown to be more affected by electroporation when oriented with their long axis parallel to the applied electric field. However, recent studies demonstrate that the preferentially affected orientation depends on the pulse parameters. To gain better insight into the influence of cell orientation on electroporation with different pulse parameters, we developed a time-dependent nonlinear numerical model where we calculated the induced transmembrane voltage and pores creation in the membrane due to electroporation. The numerical results show that the onset of electroporation is observed at lower electric field strengths for cells oriented parallel to the electric field for pulse durations ≥10 µs, and cells oriented perpendicular for pulse durations ~100 ns. For pulses of ~1 µs duration, electroporation is not very sensitive to cell orientation. Interestingly, as the electric field strength increases beyond the onset of electroporation, perpendicular cells become more affected irrespective of pulse duration. The results obtained using the developed time-dependent nonlinear model are corroborated by in vitro experimental measurements. Our study will contribute to the process of further development and optimization of pulsed-field ablation and gene therapy in cardiac treatments.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Janja Dermol-Černe
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Tina Batista Napotnik
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Sebastien Chaigne
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Olivier Bernus
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - David Benoist
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Daniel C. Sigg
- Medtronic, Cardiac Ablation Solutions, Minneapolis, MN 55105, USA
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
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28
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Qiu J, Dai M, Bai Y, Chen G. Potential Application of Pulsed Field Ablation in Ventricular Arrhythmias. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040723. [PMID: 37109681 PMCID: PMC10143478 DOI: 10.3390/medicina59040723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Pulsed field ablation (PFA) is a new ablative method for the therapy of arrhythmia. Recent preclinical and clinical studies have already demonstrated the feasibility and safety of PFA for the treatment of atrial fibrillation (AF). However, the application of PFA may not be limited to the above fields. There are some data on the application of PFA on ventricular arrhythmias (VAs), such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Further, a case report about PFA has been published recently, in which PFA was successfully applied to the ablation of premature ventricular contractions (PVCs) from the right ventricular outflow tract. Thus, we aimed to review recent research findings of PFA in ventricular ablation and evaluate the possibility of its application in VAs.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Meiyan Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Yang Bai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
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29
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Ravi V, Winterfield J, Liang J, Larsen T, Dye C, Sanders D, Skeete J, Payne J, Trohman RG, Aksu T, Sharma PS, Huang HD. Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate. Arrhythm Electrophysiol Rev 2023; 12:e04. [PMID: 37600155 PMCID: PMC10433105 DOI: 10.15420/aer.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 08/22/2023] Open
Abstract
Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with ischaemic and non-ischaemic cardiomyopathies. In most patients, the primary strategy of VT catheter ablation is based on the identification of critical components of reentry circuits and modification of abnormal substrate which can initiate reentry. Despite technological advancements in catheter design and improved ability to localise abnormal substrates, putative circuits and site of origins of ventricular arrhythmias (VAs), current technologies remain inadequate and durable success may be elusive when the critical substrate is deep or near to critical structures that are at risk of collateral damage. In this article, we review the available and potential future non-surgical investigational approaches for treatment of VAs and discuss the viability of these modalities.
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Affiliation(s)
- Venkatesh Ravi
- Saint Francis Heart and Vascular Institute, Tulsa, OK, US
| | - Jeffrey Winterfield
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, US
| | - Jackson Liang
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Timothy Larsen
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Cicely Dye
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - David Sanders
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Jamario Skeete
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Josh Payne
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Richard G Trohman
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Parikshit S Sharma
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Henry D Huang
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
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30
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Kawamura I, Reddy VY, Santos-Gallego CG, Wang BJ, Chaudhry HW, Buck ED, Mavroudis G, Jerrell S, Schneider CW, Speltz M, Dukkipati SR, Koruth JS. Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine. Circ Arrhythm Electrophysiol 2023; 16:e011369. [PMID: 36595634 DOI: 10.1161/circep.122.011369] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) has recently been shown to penetrate ischemic scar, but details on its efficacy, risk of arrhythmias, and imaging insights are lacking. In a porcine model of myocardial scar, we studied the ability of ventricular PFA to penetrate scarred tissue, induce ventricular arrhythmias, and assess the influence of QRS gating during pulse delivery. METHODS Of a total of 6 swine, 5 underwent coronary occlusion and 1 underwent radiofrequency ablation to create infarct scar and iatrogenic scar models, respectively. Two additional swine served as healthy controls. An 8 Fr focal PFA catheter was used to deliver bipolar, biphasic PFA (2.0 kV) lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography over both scarred and healthy myocardium. Swine underwent magnetic resonance imaging 2-7 days post-PFA. RESULTS PFA successfully penetrated scar without significant difference in lesion depth between lesion at the infarct border (5.9±1.0 mm, n=41) and healthy myocardium (5.7±1.3 mm, n=26; P=0.53). PFA penetration of both infarct and iatrogenic radiofrequency abalation scar was observed in all examined sections. Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated applications, whereas no ventricular arrhythmias occurred during gated PFA applications (0 of 64 [0%]). Dark-blood late-gadolinium-enhanced sequences allowed for improved endocardial border detection as well as lesion boundaries compared with conventional bright-blood late-gadolinium-enhanced sequences. CONCLUSIONS PFA penetrates infarct and iatrogenic scar successfully to create deep lesions. Gated delivery eliminates the occurrence of ventricular arrhythmias observed with ungated porcine PFA. Optimized magnetic resonance imaging sequences can be helpful in detecting lesion boundaries.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | | | - Bingyan J Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Hina W Chaudhry
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Eric D Buck
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - George Mavroudis
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Samantha Jerrell
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Christopher W Schneider
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | | | | | - Jacob S Koruth
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
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31
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Ouss A, van Stratum L, van der Voort P, Dekker L. First in human pulsed field ablation to treat scar-related ventricular tachycardia in ischemic heart disease: a case report. J Interv Card Electrophysiol 2022; 66:509-510. [PMID: 36308578 DOI: 10.1007/s10840-022-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandre Ouss
- Heart Center, Catharina Hospital, Eindhoven, The Netherlands.
| | | | | | - Lukas Dekker
- Heart Center, Catharina Hospital, Eindhoven, The Netherlands
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32
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Kattel S, Enriquez AD. Contemporary approach to catheter ablation of ventricular tachycardia in nonischemic cardiomyopathy. J Interv Card Electrophysiol 2022; 66:793-805. [PMID: 36056222 DOI: 10.1007/s10840-022-01363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Nonischemic cardiomyopathy (NICM) comprises a heterogenous group of disorders with myocardial dysfunction unrelated to significant coronary disease. As the use of implantable defibrillators has increased in this patient population, catheter ablation is being utilized more frequently to treat NICM patients with ventricular tachycardia (VT). Progress has been made in identifying multiple subtypes of NICM with variable scar patterns. The distribution of scar is often mid-myocardial and subepicardial, and identifying and ablating this substrate can be challenging. Here, we will review the current understanding of NICM subtypes and the outcomes of VT ablation in this population. We will discuss the use of cardiac imaging, electrocardiography, and electroanatomic mapping to define the VT substrate and the ablation techniques required to successfully prevent VT recurrence.
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Affiliation(s)
- Sharma Kattel
- Cardiovascular Medicine, Yale University School of Medicine, PO Box 208017, New Haven, CT, 06520-8017, USA
| | - Alan D Enriquez
- Cardiovascular Medicine, Yale University School of Medicine, PO Box 208017, New Haven, CT, 06520-8017, USA.
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