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Tang JE, Guirguis F, Stein EJ, Essandoh MK, Iyer MH. Pulse Field Ablation: The Electric Future of Cardiac Ablation. J Cardiothorac Vasc Anesth 2024; 38:2139-2142. [PMID: 39004568 DOI: 10.1053/j.jvca.2024.06.028] [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: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Fady Guirguis
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Erica J Stein
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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2
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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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Wang Z, Liang M, Sun J, Zhang J, Han Y. A New Hope for the Treatment of Atrial Fibrillation: Application of Pulsed-Field Ablation Technology. J Cardiovasc Dev Dis 2024; 11:175. [PMID: 38921675 PMCID: PMC11204042 DOI: 10.3390/jcdd11060175] [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: 04/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
In recent years, the prevalence of and mortality associated with cardiovascular diseases have been rising in most countries and regions. AF is the most common arrhythmic condition, and there are several treatment options for AF. Pulmonary vein isolation is an effective treatment for AF and is the cornerstone of current ablation techniques, which have one major limitation: even when diagnosed and treated at a facility that specializes in ablation, patients have a greater chance of recurrence. Therefore, there is a need to develop better ablation techniques for the treatment of AF. This article first compares the current cryoablation (CBA) and radiofrequency ablation (RFA) techniques for the treatment of AF and discusses the utility and advantages of the development of pulsed-field ablation (PFA) technology. The current research on PFA is summarized from three perspectives, namely, simulation experiments, animal experiments, and clinical studies. The results of different stages of experiments are summarized, especially during animal studies, where pulmonary vein isolation was carried out effectively without causing injury to the phrenic nerve, esophagus, and pulmonary veins, with higher safety and shorter incision times. This paper focuses on a review of various a priori and clinical studies of this new technique for the treatment of AF.
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Affiliation(s)
- Zhen Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China;
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, Shenyang 110016, China
| | - Jingyang Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Jie Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, Shenyang 110016, China
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Kulbacka J, Rembiałkowska N, Radzevičiūtė-Valčiukė E, Szewczyk A, Novickij V. Cardiomyocytes Permeabilization and Electrotransfection by Unipolar and Bipolar Asymmetric Electric Field Pulses. Bioelectricity 2024; 6:91-96. [PMID: 39119571 PMCID: PMC11304875 DOI: 10.1089/bioe.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Short electric field pulses represent a novel potential approach for achieving uniform electroporation within tissue containing elongated cells oriented in various directions, such as electroporation-based cardiac ablation procedures. In this study, we investigated how electroporation with nanosecond pulses with respect to different pulse shapes (unipolar, bipolar, and asymmetric) influences cardiomyocyte permeabilization and gene transfer. For this purpose, rat cardiomyocytes (H9c2) were used. The efficacy of the pulsed electric field protocols was assessed by flow cytometry and electrogene transfer by fluorescent and holotomographic microscopy. The response of the cells was assessed by the metabolic activity (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide [MTT] assay), F-actin distribution in cells by confocal microscopy, and muscle atrophy F-box (MAFbx) marker. We show nano- and microsecond pulse protocols, which are not cytotoxic for cardiac muscle cells and can be efficiently used for gene electrotransfection. Asymmetric nanosecond pulsed electric fields were similarly efficient in plasmid delivery as microsecond and millisecond protocols. However, the millisecond protocol induced a higher MAFbx expression in H9c2 cells.
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Affiliation(s)
- Julita Kulbacka
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Nina Rembiałkowska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Eivina Radzevičiūtė-Valčiukė
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Anna Szewczyk
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Vitalij Novickij
- Department of Immunology and Bioelectrochemistry, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Institute of High Magnetic Fields, Vilnius Gediminas Technical University, Vilnius, Lithuania
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Awad SS, Azeez EF, Taha MO, El-Naggar WM, El-Damaty A. Arrhythmogenicity of anti-tachycardia pacing in patients with implantable cardioverter defibrillator. Egypt Heart J 2023; 75:44. [PMID: 37266828 DOI: 10.1186/s43044-023-00369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Anti-tachycardia pacing therapy (ATP) has shown comparable efficacy to shock therapy in ventricular tachycardia (VT) termination with better quality of life. However, some ATPs may lead to VT acceleration or degeneration to ventricular fibrillation (VF), which will result in more ICD shocks. The aim of this study was to investigate the predictors of VT acceleration by ATP therapy in a real-life patient cohort. RESULTS We retrospectively reviewed 448 monomorphic VT episodes that required ATP therapy in 60 patients with structural heart diseases implanted with ICD or CRTD. The clinical data of the patients and the episodes' details were evaluated. We found that patients with a higher ejection fraction (EF) were more likely to be cardioverted by ATP therapy (P: 0.024). VT acceleration was more frequent in patients with lower EF (mean 31.24 ± 4.08) compared with the non-accelerated patients with higher EF (mean 37.00 ± 9.4, P: 0.016). The percentage of accelerated episodes was 8.5%. VT episodes with a mean cycle length (CL) < 310 ms are more likely to accelerate (sensitivity 76.3%, specificity 67.7%, PPV value 45%, NPV 86%, and AUC 0.790). There was a statistically significant difference in the accelerated VT episodes as compared to non-accelerated episodes regarding the number of ATP bursts (mean 3.66 ± 2.22 vs. 1.76 ± 1.35, P: < 0.001), ramp (23.7% vs. 4.2%, P: < 0.001), scanning (55.3% vs. 31.3%, P: 0.003) and burst adaptive cycle length (mean 83.55 ± 2.92 vs. 84.64 ± 2.61, P: 0.016). In a multivariate analysis, the VT CL, number of ATP bursts and ramp pacing predicted VT acceleration by ATP therapy. CONCLUSIONS Ventricular tachycardia in patients with low LV EF and fast VTs with a CL less than 310 ms were more likely to accelerate with ATP therapy. The number of ATP bursts and the use of ramp had a significant effect on VT acceleration. To avoid VT acceleration by ATP therapy, ramp pacing better be avoided, especially in fast VTs, and lesser number of bursts should be delivered.
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Affiliation(s)
- Sherien Samy Awad
- Egyptian Ministry of Health, Al Kasr Al Aini Street, Old Cairo, 11562, Cairo Governorate, Egypt.
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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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Sowa PW, Kiełbik AS, Pakhomov AG, Gudvangen E, Mangalanathan U, Adams V, Pakhomova ON. How to alleviate cardiac injury from electric shocks at the cellular level. Front Cardiovasc Med 2022; 9:1004024. [PMID: 36620647 PMCID: PMC9812960 DOI: 10.3389/fcvm.2022.1004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Electric shocks, the only effective therapy for ventricular fibrillation, also electroporate cardiac cells and contribute to the high-mortality post-cardiac arrest syndrome. Copolymers such as Poloxamer 188 (P188) are known to preserve the membrane integrity and viability of electroporated cells, but their utility against cardiac injury from cardiopulmonary resuscitation (CPR) remains to be established. We studied the time course of cell killing, mechanisms of cell death, and protection with P188 in AC16 human cardiomyocytes exposed to micro- or nanosecond pulsed electric field (μsPEF and nsPEF) shocks. A 3D printer was customized with an electrode holder to precisely position electrodes orthogonal to a cell monolayer in a nanofiber multiwell plate. Trains of nsPEF shocks (200, 300-ns pulses at 1.74 kV) or μsPEF shocks (20, 100-μs pulses at 300 V) produced a non-uniform electric field enabling efficient measurements of the lethal effect in a wide range of the electric field strength. Cell viability and caspase 3/7 expression were measured by fluorescent microscopy 2-24 h after the treatment. nsPEF shocks caused little or no caspase 3/7 activation; most of the lethally injured cells were permeable to propidium dye already at 2 h after the exposure. In contrast, μsPEF shocks caused strong activation of caspase 3/7 at 2 h and the number of dead cells grew up to 24 h, indicating the prevalence of the apoptotic death pathway. P188 at 0.2-1% reduced cell death, suggesting its potential utility in vivo to alleviate electric injury from defibrillation.
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Affiliation(s)
- Pamela W. Sowa
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States,Laboratory of Molecular and Experimental Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany,Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany,*Correspondence: Pamela W. Sowa,
| | - Aleksander S. Kiełbik
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States,Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wrocław Medical University, Wrocław, Poland
| | - Andrei G. Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States
| | - Emily Gudvangen
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States
| | - Uma Mangalanathan
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States
| | - Volker Adams
- Laboratory of Molecular and Experimental Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Olga N. Pakhomova
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, United States
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Qiu J, Lan L, Wang Y. Pulsed Electrical Field in Arrhythmia Treatment: Current Status and Future Directions. Pacing Clin Electrophysiol 2022; 45:1255-1262. [PMID: 36029174 DOI: 10.1111/pace.14586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Pulsed electrical field (PEF) ablation is a promising novel ablation modality for the treatment of arrhythmia, especially for atrial fibrillation(AF). It relies on electroporation inducing cellular permeabilization by the formation of pores in cell membranes, potentially resulting in cell death. Due to its' non-thermal nature and remarkable tissue selectivity, PEF ablation has be expected largely to replace conventional energy sources, such as radiofrequency (RF) and cryothermy. Up to now, the results in almost all clinical studies of PFA for AF ablation are optimistic, both in terms of effectiveness and safety. The possibility of clinical application of this technology to ventricular tachycardia(VT) has also been supported by several animal models. In this review, we aim to give an overview of the mechanism and technical progress of PFA in cardiac arrhythmia treatment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Lan
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Wang
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Brixius SJ, Pooth JS, Haberstroh J, Damjanovic D, Scherer C, Greiner P, Benk C, Beyersdorf F, Trummer G. Beneficial Effects of Adjusted Perfusion and Defibrillation Strategies on Rhythm Control within Controlled Automated Reperfusion of the Whole Body (CARL) for Refractory Out-of-Hospital Cardiac Arrest. J Clin Med 2022; 11:2111. [PMID: 35456204 PMCID: PMC9031732 DOI: 10.3390/jcm11082111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/27/2023] Open
Abstract
Survival and neurological outcomes after out-of-hospital cardiac arrest (OHCA) remain low. The further development of prehospital extracorporeal resuscitation (ECPR) towards Controlled Automated Reperfusion of the Whole Body (CARL) has the potential to improve survival and outcome in these patients. In CARL therapy, pulsatile, high blood-flow reperfusion is performed combined with several modified reperfusion parameters and adjusted defibrillation strategies. We aimed to investigate whether pulsatile, high-flow reperfusion is feasible in refractory OHCA and whether the CARL approach improves heart-rhythm control during ECPR. In a reality-based porcine model of refractory OHCA, 20 pigs underwent prehospital CARL or conventional ECPR. Significantly higher pulsatile blood-flow proved to be feasible, and critical hypotension was consistently prevented via CARL. In the CARL group, spontaneous rhythm conversions were observed using a modified priming solution. Applying potassium-induced secondary cardioplegia proved to be a safe and effective method for sustained rhythm conversion. Moreover, significantly fewer defibrillation attempts were needed, and cardiac arrhythmias were reduced during reperfusion via CARL. Prehospital CARL therapy thus not only proved to be feasible after prolonged OHCA, but it turned out to be superior to conventional ECPR regarding rhythm control.
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Affiliation(s)
- Sam Joé Brixius
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Jan-Steffen Pooth
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Jörg Haberstroh
- Centre for Experimental Models and Transgenic Service, Department of Experimental Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79104 Freiburg, Germany;
| | - Domagoj Damjanovic
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Christian Scherer
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Philipp Greiner
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Christoph Benk
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
| | - Georg Trummer
- Department of Cardiovascular Surgery, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, 79106 Freiburg, Germany; (J.-S.P.); (D.D.); (C.S.); (P.G.); (C.B.); (F.B.); (G.T.)
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Di Monaco A, Vitulano N, Troisi F, Quadrini F, Romanazzi I, Calvi V, Grimaldi M. Pulsed Field Ablation to Treat Atrial Fibrillation: A Review of the Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9040094. [PMID: 35448070 PMCID: PMC9030965 DOI: 10.3390/jcdd9040094] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and catheter ablation, which can be used in symptomatic patients refractory to antiarrhythmic therapy. Pulmonary vein isolation (PVI) remains the cornerstone of any ablation procedure. A major limitation of current catheter ablation procedures is important to recognize because even when the PVI is performed in highly experienced centers, PVI reconnection was documented in about 20% of patients. Therefore, better technology is needed to improve ablation lesions. One of the novelties in recent years is pulsed filed ablation (PFA), a non-thermal energy that uses trains of high-voltage, very-short-duration pulses to kill the cells. The mechanism of action of this energy consists of creating pores in the myocardiocyte cell membrane in a highly selective and tissue-specific way; this leads to death of the target cells reducing the risk of damage to surrounding non-cardiac tissues. In particular during the animal studies, PVI and atrial lines were performed effectively without PV stenosis. Using PFA directly on coronary arteries, there was no luminal narrowing, there has been no evidence of incidental phrenic nerve injury, and finally, PFA has been shown not to injure esophageal tissue when directly applied to the esophagus or indirectly through ablation in the left atrium. The aim of this review is to report all published animal and clinical studies regarding this new technology to treat paroxysmal and persistent AF.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-33-9735-1594
| | - Nicola Vitulano
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Federica Troisi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Federico Quadrini
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Imma Romanazzi
- Department of Cardiology, Policlinico “G. Rodolico”—Azienda O.U. Policlinico “G. Rodolico”—San Marco, 95125 Catania, Italy; (I.R.); (V.C.)
| | - Valeria Calvi
- Department of Cardiology, Policlinico “G. Rodolico”—Azienda O.U. Policlinico “G. Rodolico”—San Marco, 95125 Catania, Italy; (I.R.); (V.C.)
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
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Li J, Wang J, Zhang X, Zhang X, Gao H, Xiao Y. Cardiac impact of high-frequency irreversible electroporation using an asymmetrical waveform on liver in vivo. BMC Cardiovasc Disord 2021; 21:581. [PMID: 34876030 PMCID: PMC8650563 DOI: 10.1186/s12872-021-02412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background High-Frequency Irreversible Electroporation (H-FIRE) is a novel technology for non-thermal ablation. Different from Irreversible electroporation (IRE), H-FIRE delivers bipolar electrical pulses without muscle contraction and does not cause electrolysis. Currently, little is known regarding the cardiac safety during the administration of H-FIRE on liver. The aim of this study was to evaluate the changes of electrocardiogram (ECG) and biomarkers of cardiac damage during asymmetrical waveform of H-FIRE therapy in vivo. Methods The swines (n = 7) in IRE group, which used 100 pulses (2200 V, 100–100 μs configuration), were administrated with muscle relaxant under anesthesia. In the absence of muscle relaxant, 7 swines in H-FIRE group were performed with 2400 pulses (3000 V, 5–3–3–5 μs configuration). Midazolam (0.5 mg/kg) and xylazine hydrochloride (20 mg/kg) were given to induce sedation, followed by Isoflurane (2.5%, 100% oxygen, 3 L/min) to maintain sedation in all the swines. Limb lead ECG recordings were analyzed by two electrophysiologists to judge the arrhythmia. Cardiac and liver tissue was examined by pathology technique. Results The ablation zones were larger in H-FIRE than IRE. Both IRE and H-FIRE did not affect the autonomous cardiac rhythm. Even when the electrical signal of IRE and H-FIRE fell on ventricular vulnerable period. Moreover, cTnI in IRE group showed an increase in 4 h after ablation, and decreased to baseline 72 h after ablation. However, cTnI showed no significant change during the administration of H-FIRE. Conclusions The study suggests an asymmetrical waveform for H-FIRE is a promising measure for liver ablation. The results were based on normal liver and the swines without potential cardiac diseases. With the limitations of these facts, asymmetrical waveform for H-FIRE of liver tissue seems relatively safe without major cardiac complications. The safety of asymmetrical waveform for H-FIRE needs to evaluate in future.
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Affiliation(s)
- Jing Li
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.,Department of MRI, Affiliated Hospital, Logistics University of Chinese Peoples Armed Police Forces, Tianjin, 300162, China
| | - Jingjing Wang
- Department of Critical Care Medicine, Tianjin First Center Hospital, Tianjin, 300192, China
| | - Xiaobo Zhang
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Hongmei Gao
- Department of Critical Care Medicine, Tianjin First Center Hospital, Tianjin, 300192, China.
| | - Yueyong Xiao
- Department of Radiology, The First Medical Center of Chinese, PLA General Hospital, Beijing, China.
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12
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Roth BJ. Bidomain modeling of electrical and mechanical properties of cardiac tissue. BIOPHYSICS REVIEWS 2021; 2:041301. [PMID: 38504719 PMCID: PMC10903405 DOI: 10.1063/5.0059358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/15/2021] [Indexed: 03/21/2024]
Abstract
Throughout the history of cardiac research, there has been a clear need to establish mathematical models to complement experimental studies. In an effort to create a more complete picture of cardiac phenomena, the bidomain model was established in the late 1970s to better understand pacing and defibrillation in the heart. This mathematical model has seen ongoing use in cardiac research, offering mechanistic insight that could not be obtained from experimental pursuits. Introduced from a historical perspective, the origins of the bidomain model are reviewed to provide a foundation for researchers new to the field and those conducting interdisciplinary research. The interplay of theory and experiment with the bidomain model is explored, and the contributions of this model to cardiac biophysics are critically evaluated. Also discussed is the mechanical bidomain model, which is employed to describe mechanotransduction. Current challenges and outstanding questions in the use of the bidomain model are addressed to give a forward-facing perspective of the model in future studies.
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Affiliation(s)
- Bradley J. Roth
- Department of Physics, Oakland University, Rochester, Michigan 48309, USA
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13
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Electroporation safety factor of 300 nanosecond and 10 millisecond defibrillation in Langendorff-perfused rabbit hearts. PLoS One 2021; 16:e0257287. [PMID: 34559811 PMCID: PMC8462679 DOI: 10.1371/journal.pone.0257287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS Recently, a new defibrillation modality using nanosecond pulses was shown to be effective at much lower energies than conventional 10 millisecond monophasic shocks in ex vivo experiments. Here we compare the safety factors of 300 nanosecond and 10 millisecond shocks to assess the safety of nanosecond defibrillation. METHODS AND RESULTS The safety factor, i.e. the ratio of median effective doses (ED50) for electroporative damage and defibrillation, was assessed for nanosecond and conventional (millisecond) defibrillation shocks in Langendorff-perfused New Zealand white rabbit hearts. In order to allow for multiple shock applications in a single heart, a pair of needle electrodes was used to apply shocks of varying voltage. Propidium iodide (PI) staining at the surface of the heart showed that nanosecond shocks had a slightly lower safety factor (6.50) than millisecond shocks (8.69), p = 0.02; while PI staining cross-sections in the electrode plane showed no significant difference (5.38 for 300 ns shocks and 6.29 for 10 ms shocks, p = 0.22). CONCLUSIONS In Langendorff-perfused rabbit hearts, nanosecond defibrillation has a similar safety factor as millisecond defibrillation, between 5 and 9, suggesting that nanosecond defibrillation can be performed safely.
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14
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Yavin HD, Higuchi K, Sroubek J, Younis A, Zilberman I, Anter E. Pulsed-Field Ablation in Ventricular Myocardium Using a Focal Catheter: The Impact of Application Repetition on Lesion Dimensions. Circ Arrhythm Electrophysiol 2021; 14:e010375. [PMID: 34459210 DOI: 10.1161/circep.121.010375] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Hagai D Yavin
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Koji Higuchi
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Israel Zilberman
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
| | - Elad Anter
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH.,Mark-Josephson and Andrew Wit Research Laboratory, Department of Cardiovascular & Metabolic Sciences (H.D.Y., K.H., J.S., A.Y., I.Z., E.A.), Cleveland Clinic, Lerner Research Institute, Cleveland, OH
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15
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Reversible Atrioventricular Conduction Impairment Following Bipolar Nanosecond Electroporation of the Interventricular Septum. JACC Clin Electrophysiol 2021; 7:255-257. [PMID: 33602409 DOI: 10.1016/j.jacep.2020.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
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16
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McBride S, Avazzadeh S, Wheatley AM, O’Brien B, Coffey K, Elahi A, O’Halloran M, Quinlan LR. Ablation Modalities for Therapeutic Intervention in Arrhythmia-Related Cardiovascular Disease: Focus on Electroporation. J Clin Med 2021; 10:jcm10122657. [PMID: 34208708 PMCID: PMC8235263 DOI: 10.3390/jcm10122657] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
Targeted cellular ablation is being increasingly used in the treatment of arrhythmias and structural heart disease. Catheter-based ablation for atrial fibrillation (AF) is considered a safe and effective approach for patients who are medication refractory. Electroporation (EPo) employs electrical energy to disrupt cell membranes which has a minimally thermal effect. The nanopores that arise from EPo can be temporary or permanent. Reversible electroporation is transitory in nature and cell viability is maintained, whereas irreversible electroporation causes permanent pore formation, leading to loss of cellular homeostasis and cell death. Several studies report that EPo displays a degree of specificity in terms of the lethal threshold required to induce cell death in different tissues. However, significantly more research is required to scope the profile of EPo thresholds for specific cell types within complex tissues. Irreversible electroporation (IRE) as an ablative approach appears to overcome the significant negative effects associated with thermal based techniques, particularly collateral damage to surrounding structures. With further fine-tuning of parameters and longer and larger clinical trials, EPo may lead the way of adapting a safer and efficient ablation modality for the treatment of persistent AF.
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Affiliation(s)
- Shauna McBride
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Sahar Avazzadeh
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Antony M. Wheatley
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
| | - Barry O’Brien
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 R6W6 Galway, Ireland; (B.O.); (K.C.)
| | - Ken Coffey
- AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 R6W6 Galway, Ireland; (B.O.); (K.C.)
| | - Adnan Elahi
- Translational Medical Device Lab (TMDL), Lamb Translational Research Facility, University College Hospital Galway, H91 V4AY Galway, Ireland; (A.E.); (M.O.)
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, H91 HX31 Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Lab (TMDL), Lamb Translational Research Facility, University College Hospital Galway, H91 V4AY Galway, Ireland; (A.E.); (M.O.)
| | - Leo R. Quinlan
- Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland; (S.M.); (S.A.); (A.M.W.)
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, H92 W2TY Galway, Ireland
- Correspondence:
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17
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Clementy N, Bodin A, Bisson A, Teixeira-Gomes AP, Roger S, Angoulvant D, Labas V, Babuty D. The Defibrillation Conundrum: New Insights into the Mechanisms of Shock-Related Myocardial Injury Sustained from a Life-Saving Therapy. Int J Mol Sci 2021; 22:5003. [PMID: 34066832 PMCID: PMC8125879 DOI: 10.3390/ijms22095003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Implantable cardiac defibrillators (ICDs) are recommended to prevent the risk of sudden cardiac death. However, shocks are associated with an increased mortality with a dose response effect, and a strategy of reducing electrical therapy burden improves the prognosis of implanted patients. We review the mechanisms of defibrillation and its consequences, including cell damage, metabolic remodeling, calcium metabolism anomalies, and inflammatory and pro-fibrotic remodeling. Electrical shocks do save lives, but also promote myocardial stunning, heart failure, and pro-arrhythmic effects as seen in electrical storms. Limiting unnecessary implantations and therapies and proposing new methods of defibrillation in the future are recommended.
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Affiliation(s)
- Nicolas Clementy
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Alexandre Bodin
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Ana-Paula Teixeira-Gomes
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Sebastien Roger
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Denis Angoulvant
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
| | - Valérie Labas
- Plate-forme de Chirurgie et d’Imagerie pour la Recherche et l’Enseignement (CIRE), INRA, Université de Tours, CHU de Tours, 37380 Nouzilly, France; (A.-P.T.-G.); (V.L.)
| | - Dominique Babuty
- Service de Cardiologie, Hôpital Trousseau, Université de Tours, 37044 Tours, France; (A.B.); (A.B.); (D.A.); (D.B.)
- Transplantation, Immunologie et Inflammation T2I-EA 4245, Université de Tours, 37044 Tours, France;
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18
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La Rosa G, Quintanilla JG, Salgado R, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Villacastín J, Jalife J, Pérez-Castellano N, Filgueiras-Rama D. Anatomical targets and expected outcomes of catheter-based ablation of atrial fibrillation in 2020. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:341-359. [PMID: 33283883 DOI: 10.1111/pace.14140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
Anatomical-based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter-based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point-by-point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow-up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.
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Affiliation(s)
- Giulio La Rosa
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Jorge G Quintanilla
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Salgado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - David Filgueiras-Rama
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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19
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A framework of current based defibrillation improves defibrillation efficacy of biphasic truncated exponential waveform in rabbits. Sci Rep 2021; 11:1586. [PMID: 33452293 PMCID: PMC7810866 DOI: 10.1038/s41598-020-80521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
Defibrillation is accomplished by the passage of sufficient current through the heart to terminate ventricular fibrillation (VF). Although current-based defibrillation has been shown to be superior to energy-based defibrillation with monophasic waveforms, defibrillators with biphasic waveforms still use energy as a therapeutic dosage. In the present study, we propose a novel framework of current-based, biphasic defibrillation grounded in transthoracic impedance (TTI) measurements: adjusting the charging voltage to deliver the desired current based on the energy setting and measured pre-shock TTI; and adjusting the pulse duration to deliver the desired energy based on the output current and intra-shock TTI. The defibrillation efficacy of current-based defibrillation was compared with that of energy-based defibrillation in a simulated high impedance rabbit model of VF. Cardiac arrest was induced by pacing the right ventricle for 60 s in 24 New Zealand rabbits (10 males). A defibrillatory shock was applied with one of the two defibrillators after 90 s of VF. The defibrillation thresholds (DFTs) at different pathway impedances were determined utilizing a 5-step up-and-down protocol. The procedure was repeated after an interval of 5 min. A total of 30 fibrillation events and defibrillation attempts were investigated for each animal. The pulse duration was significantly shorter, and the waveform tilt was much lower for the current-based defibrillator. Compared with energy-based defibrillation, the energy, peak voltage, and peak current DFT were markedly lower when the pathway impedance was > 120 Ω, but there were no differences in DFT values when the pathway impedance was between 80 and 120 Ω for current-based defibrillation. Additionally, peak voltage and the peak current DFT were significantly lower for current-based defibrillation when the pathway impedance was < 80 Ω. In sum, a framework of adjusting the charging voltage and shock duration to deliver constant energy for low impedance and constant current for high impedance via pre-shock and intra-shock impedance measurements, greatly improved the defibrillation efficacy of high impedance by lowering the energy DFT.
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20
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O'Neill CH, Martin RCG. Cardiac synchronization and arrhythmia during irreversible electroporation. J Surg Oncol 2020; 122:407-411. [PMID: 32483842 DOI: 10.1002/jso.26041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Irreversible electroporation (IRE) is a nonthermal electrical tumor ablative strategy for unresectable tumors. IRE is relatively safe around critical structures but may induce cardiac arrhythmia when its delivery is not synchronized to the cardiac cycle. We performed a systematic literature review to determine rates of arrhythmia when IRE was utilized with or without cardiac synchronization. METHODS An online literature search was conducted with additional hand selection of articles. Data were extracted and pooled analyses were performed. RESULTS Twelve articles were included in analysis. IRE was performed for 481 patients; 46% hepatic tumors (n = 223), 36% pancreatic lesions (n = 168), and multiple other locations including prostate. Synchronization was performed on 422 patients. Arrhythmias were noted in 3.7% of cases (n = 18/481); cardiac synchronization: 1.2% (n = 5/422) vs unsynchronized: 22.0% (n = 13/59), P < .0001. These events occurred in every organ except the prostate. CONCLUSIONS IRE remains a potent technology for unresectable tumors, but arrhythmia is a clinical concern. This literature review confirms that cardiac gating should be used in all cases outside of prostate to prevent this potentially serious adverse event.
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Affiliation(s)
- Conor H O'Neill
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
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21
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Cardiac Spiral Wave Termination by Linear Regional Cooling Toward the Anatomical Boundary of the Heart. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00517-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose
We hypothesized that linear regional cooling (LRC) toward the atrio-ventricular groove (AV-G) can move the spiral wave (SW) center to the AV-G effectively and terminate SW. The effectiveness of LRC in ex vivo 2D ventricle rabbit experiments was tested.
Methods
We developed an experimental system to operate LRC and optical mapping simultaneously. To realize simultaneous cooling and optical mapping, a transparent cooling device was developed. LRC for 60 s toward 2D subepicardial ventricular myocardium of Langendorff-perfused rabbit hearts (n = 4) was conducted during constant pacing and persistent ventricular tachyarrhythmias (VTs).
Results
Action potential duration at 90% repolarization (APD90) at the cooling area was prolonged by LRC from 187 to 228 ms. 41% of persistent VTs were terminated by LRC (12/29 cases). Cases where the original SW center moved toward the AV-G were observed via optical mapping. However, there were some cases where VT was not terminated by LRC. When the action potential duration (APD) of VT sustained cases were analyzed, LRC prolonged APD, but the APD prolonged area did not move toward the AV-G in most VT sustained cases
Conclusion
Proper LRC toward the AV-G near the original SW center could move this center toward the AV-G and terminate SW excitation.
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22
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Bradley CJ, Haines DE. Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2136-2147. [DOI: 10.1111/jce.14414] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Christopher J. Bradley
- Department of Cardiovascular Medicine, Beaumont HospitalOakland University William Beaumont School of Medicine Royal Oak Michigan
| | - David E. Haines
- Department of Cardiovascular Medicine, Beaumont HospitalOakland University William Beaumont School of Medicine Royal Oak Michigan
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23
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Neuber JU, Varghese F, Pakhomov AG, Zemlin CW. Using Nanosecond Shocks for Cardiac Defibrillation. Bioelectricity 2019; 1:240-246. [PMID: 32685917 DOI: 10.1089/bioe.2019.0030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The purpose of this review article is to summarize our current understanding of the efficacy and safety of cardiac defibrillation with nanosecond shocks. Experiments in isolated hearts, using optical mapping of the electrical activity, have demonstrated that nanosecond shocks can defibrillate with lower energies than conventional millisecond shocks. Single defibrillation strength nanosecond shocks do not cause obvious damage, but repeated stimulation leads to deterioration of the hearts. In isolated myocytes, nanosecond pulses can also stimulate at lower energies than at longer pulses and cause less electroporation (propidium uptake). The mechanism is likely electroporation of the plasma membrane. Repeated stimulation leads to distorted calcium gradients.
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Affiliation(s)
- Johanna U Neuber
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia
| | - Frency Varghese
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andrei G Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia
| | - Christian W Zemlin
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia
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Antoneli PC, Goulart JT, Bonilha I, de Carvalho DD, de Oliveira PX. Heart defibrillation: relationship between pacing threshold and defibrillation probability. Biomed Eng Online 2019; 18:96. [PMID: 31519192 PMCID: PMC6743100 DOI: 10.1186/s12938-019-0715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considering the clinical importance of the ventricular fibrillation and that the most used therapy to reverse it has a critical side effect on the cardiac tissue, it is desirable to optimize defibrillation parameters to increase its efficiency. In this study, we investigated the influence of stimuli duration on the relationship between pacing threshold and defibrillation probability. RESULTS We found out that 0.5-ms-long pulses had a lower ratio of defibrillation probability to the pacing threshold, although the higher the pulse duration the lower is the electric field intensity required to defibrillate the hearts. CONCLUSION The appropriate choice of defibrillatory shock parameters is able to increase the efficiency of the defibrillation improving the survival chances after the occurrence of a severe arrhythmia. The relationship between pulse duration and the probability of reversal of fibrillation shows that this parameter cannot be underestimated in defibrillator design since different pulse durations have different levels of safety.
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Affiliation(s)
- Priscila C Antoneli
- Department of Biomedical Engineering, School of Electrical and Computer Engineering-FEEC, University of Campinas-UNICAMP, Rua Alexander Fleming 163, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-881, Brazil
| | - Jair T Goulart
- Department of Physiological Sciences, Institute of Biology, University of Brasilia-UnB, Campus Universitário Darcy Ribeiro-Asa Norte, Brasília, DF, CEP 70910-900, Brazil
| | - Isabella Bonilha
- Laboratory of Myocardial Ischemia/Reperfusion, Faculty of Medical Science, University of Campinas-UNICAMP, Rua Cinco de Junho, 350, Bloco 1, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-877, Brazil
| | - Daniela D de Carvalho
- Laboratory of Myocardial Ischemia/Reperfusion, Faculty of Medical Science, University of Campinas-UNICAMP, Rua Cinco de Junho, 350, Bloco 1, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-877, Brazil
| | - Pedro X de Oliveira
- Department of Biomedical Engineering, School of Electrical and Computer Engineering-FEEC, University of Campinas-UNICAMP, Rua Alexander Fleming 163, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-881, Brazil. .,Center for Biomedical Engineering, University of Campinas-UNICAMP, Rua Alexander Fleming 163, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-881, Brazil.
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25
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Azarov JE, Semenov I, Casciola M, Pakhomov AG. Excitation of murine cardiac myocytes by nanosecond pulsed electric field. J Cardiovasc Electrophysiol 2019; 30:392-401. [PMID: 30582656 DOI: 10.1111/jce.13834] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Opening of voltage-gated sodium channels takes tens to hundreds of microseconds, and mechanisms of their opening by nanosecond pulsed electric field (nsPEF) stimuli remain elusive. This study was aimed at uncovering the mechanisms of how nsPEF elicits action potentials (APs) in cardiomyocytes. METHODS AND RESULTS Fluorescent imaging of optical APs (FluoVolt) and Ca2+ -transients (Fluo-4) was performed in enzymatically isolated murine ventricular cardiomyocytes stimulated by 200-nanosecond trapezoidal pulses. nsPEF stimulation evoked tetrodotoxin-sensitive APs accompanied or preceded by slow sustained depolarization (SSD) and, in most cells, by transient afterdepolarization waves. SSD threshold was lower than the AP threshold (1.26 ± 0.03 vs 1.34 ± 0.03 kV/cm, respectively, P < 0.001). Inhibition of l-type calcium and sodium-calcium exchanger currents reduced the SSD amplitude and increased the AP threshold ( P < 0.05). The threshold for Ca 2+ -transients (1.40 ± 0.04 kV/cm) was not significantly affected by a tetrodotoxin-verapamil cocktail, suggesting the activation of a Ca 2+ entry pathway independent from the opening of Na + or Ca 2+ voltage-gated channels. Removal of external Ca 2+ decreased the SSD amplitude ( P = 0.004) and blocked Ca 2+ -transients but not APs. The incidence of transient afterdepolarization waves was decreased by verapamil and by removal of external Ca 2+ ( P = 0.002). CONCLUSIONS The study established that nsPEF stimulation caused calcium entry into cardiac myocytes (including routes other than voltage-gated calcium channels) and SSD. Tetrodotoxin-sensitive APs were mediated by SSD, whose amplitude depended on the calcium entry. Plasma membrane electroporation was the most likely primary mechanism of SSD with additional contribution from l-type calcium and sodium-calcium exchanger currents.
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Affiliation(s)
- Jan E Azarov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia.,Laboratory of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.,Department of Physiology, Medical Institute of Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - Iurii Semenov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia
| | - Maura Casciola
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia
| | - Andrei G Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia
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26
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Varghese F, Neuber JU, Xie F, Philpott JM, Pakhomov AG, Zemlin CW. Low-energy defibrillation with nanosecond electric shocks. Cardiovasc Res 2018; 113:1789-1797. [PMID: 29016714 DOI: 10.1093/cvr/cvx172] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023] Open
Abstract
Aims Reliable defibrillation with reduced energy deposition has long been the focus of defibrillation research. We studied the efficacy of single shocks of 300 ns duration in defibrillating rabbit hearts as well as the tissue damage they may cause. Methods and results New Zealand white rabbit hearts were Langendorff-perfused and two planar electrodes were placed on either side of the heart. Shocks of 300 ns duration and 0.3-3 kV amplitude were generated with a transmission line generator. Single nanosecond shocks consistently induced waves of electrical activation, with a stimulation threshold of 0.9 kV (over 3 cm) and consistent activation for shock amplitudes of 1.2 kV or higher (9/9 successful attempts). We induced fibrillation (35 episodes in 12 hearts) and found that single shock nanosecond-defibrillation could consistently be achieved, with a defibrillation threshold of 2.3-2.4 kV (over 3 cm), and consistent success at 3 kV (11/11 successful attempts). Shocks uniformly depolarized the tissue, and the threshold energy needed for nanosecond defibrillation was almost an order of magnitude lower than the energy needed for defibrillation with a monophasic 10 ms shock delivered with the same electrode configuration. For the parameters studied here, nanosecond defibrillation caused no baseline shift of the transmembrane potential (that could be indicative of electroporative damage), no changes in action potential duration, and only a brief change of diastolic interval, for one beat after the shock was delivered. Histological staining with tetrazolium chloride and propidium iodide showed that effective defibrillation was not associated with tissue death or with detectable electroporation anywhere in the heart (six hearts). Conclusion Nanosecond-defibrillation is a promising technology that may allow clinical defibrillation with profoundly reduced energies.
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Affiliation(s)
- Frency Varghese
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, USA.,Center for Bioelectrics, Old Dominion University, 4211 Monarch Way, Norfolk, VA 23508, USA
| | - Johanna U Neuber
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, USA.,Center for Bioelectrics, Old Dominion University, 4211 Monarch Way, Norfolk, VA 23508, USA
| | - Fei Xie
- Department of Engineering, Mount Vernon Nazarene University, Mount Vernon, OH, USA
| | | | - Andrei G Pakhomov
- Center for Bioelectrics, Old Dominion University, 4211 Monarch Way, Norfolk, VA 23508, USA
| | - Christian W Zemlin
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, USA.,Center for Bioelectrics, Old Dominion University, 4211 Monarch Way, Norfolk, VA 23508, USA
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27
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28
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Kostrzewa M, Tueluemen E, Rudic B, Rathmann N, Akin I, Henzler T, Liebe V, Schoenberg SO, Borggrefe M, Diehl SJ. Cardiac impact of R-wave triggered irreversible electroporation therapy. Heart Rhythm 2018; 15:1872-1879. [PMID: 30017817 DOI: 10.1016/j.hrthm.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear. OBJECTIVE The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects. METHODS In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro-brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months. RESULTS In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients. CONCLUSION Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.
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Affiliation(s)
- Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Erol Tueluemen
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Boris Rudic
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Volker Liebe
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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29
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de Freitas JANLF, Dos Santos Costa Leomil F, Zoccoler M, Antoneli PC, de Oliveira PX. Cardiomyocyte lethality by multidirectional stimuli. Med Biol Eng Comput 2018; 56:2177-2184. [PMID: 29845489 DOI: 10.1007/s11517-018-1848-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
Multidirectional defibrillation protocols have shown better efficiency than monodirectional; still, no testing was performed to assess cell lethality. We investigated lethality of multidirectional defibrillator-like shocks on isolated cardiomyocytes. Cells were isolated from adult male Wistar rats and plated into a perfusion chamber. Electrical field stimulation threshold (ET) was obtained, and cells were paced with suprathreshold bipolar electrical field (E) pulses. Either one monodirectional high-intensity electrical field (HEF) pulse aligned at 0° (group Mono0) or 60° (group Mono60) to cell major axis or a multidirectional sequence of three HEF pulses aligned at 0°, 60°, and 120° each was applied. If cell recovered from shock, pacing was resumed, and a higher amplitude HEF, proportional to ET, was applied. The sequence was repeated until cell death. Lethality curves were built by means of survival analysis from sub-lethal and lethal E. Non-linear fit was performed, and E values corresponding to 50% probability of lethality (E50) were compared. Multidirectional groups presented lethality curves similar to Mono0. Mono60 displayed the highest E50. The novel data endorse the idea of multidirectional stimuli being safer because their effects on lethality of individual cells were equal to a single monodirectional stimulus, while their defibrillatory threshold is lower. Graphical abstract Monodirectional and multidirectional lethality protocol comparison on isolated rat cardiomyocytes. The heart image is a derivative of "3D Heart in zBrush" ( https://vimeo.com/65568770 ) by Laloxl, used under CC BY 3.0 ( https://creativecommons.org/licenses/by/3.0/legalcode )/image extracted from original video.
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Affiliation(s)
| | | | - Marcelo Zoccoler
- Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, São Paulo, Brazil.
| | - Priscila Correia Antoneli
- Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, São Paulo, Brazil
| | - Pedro Xavier de Oliveira
- Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, São Paulo, Brazil.,Center for Biomedical Engineering, University of Campinas, Campinas, São Paulo, Brazil
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Semenov I, Grigoryev S, Neuber JU, Zemlin CW, Pakhomova ON, Casciola M, Pakhomov AG. Excitation and injury of adult ventricular cardiomyocytes by nano- to millisecond electric shocks. Sci Rep 2018; 8:8233. [PMID: 29844431 PMCID: PMC5974370 DOI: 10.1038/s41598-018-26521-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022] Open
Abstract
Intense electric shocks of nanosecond (ns) duration can become a new modality for more efficient but safer defibrillation. We extended strength-duration curves for excitation of cardiomyocytes down to 200 ns, and compared electroporative damage by proportionally more intense shocks of different duration. Enzymatically isolated murine, rabbit, and swine adult ventricular cardiomyocytes (VCM) were loaded with a Ca2+ indicator Fluo-4 or Fluo-5N and subjected to shocks of increasing amplitude until a Ca2+ transient was optically detected. Then, the voltage was increased 5-fold, and the electric cell injury was quantified by the uptake of a membrane permeability marker dye, propidium iodide. We established that: (1) Stimuli down to 200-ns duration can elicit Ca2+ transients, although repeated ns shocks often evoke abnormal responses, (2) Stimulation thresholds expectedly increase as the shock duration decreases, similarly for VCMs from different species, (3) Stimulation threshold energy is minimal for the shortest shocks, (4) VCM orientation with respect to the electric field does not affect the threshold for ns shocks, and (5) The shortest shocks cause the least electroporation injury. These findings support further exploration of ns defibrillation, although abnormal response patterns to repetitive ns stimuli are of a concern and require mechanistic analysis.
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Affiliation(s)
- Iurii Semenov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Sergey Grigoryev
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Johanna U Neuber
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23508, USA
| | - Christian W Zemlin
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.,Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, 23508, USA
| | - Olga N Pakhomova
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Maura Casciola
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA
| | - Andrei G Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, 23508, USA.
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Markelc B, Bellard E, Sersa G, Jesenko T, Pelofy S, Teissié J, Frangez R, Rols MP, Cemazar M, Golzio M. Increased permeability of blood vessels after reversible electroporation is facilitated by alterations in endothelial cell-to-cell junctions. J Control Release 2018; 276:30-41. [PMID: 29476881 DOI: 10.1016/j.jconrel.2018.02.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/24/2018] [Accepted: 02/19/2018] [Indexed: 12/18/2022]
Abstract
Delivery of electric field pulses, i.e. electroporation (EP), to tissues has been shown to have a blood flow modifying effect. Indeed, the diameter of blood vessels exposed to EP is immediately reduced resulting in blood flow abrogation, followed by an increase in vascular permeability. The main cause of the increased permeability remains unknown. The aim of this study was to determine whether the in vivo effects of EP on permeability of blood vessels are linked to the permeabilization of endothelial cells' membrane (EC) and/or disruption of cell-to-cell junctions. We used a dorsal window chamber model in C57Bl/6 mice coupled with multiphoton microscopy and fluorescently labelled antibodies against PECAM-1 (CD31) to visualize endothelial cell-to-cell junctions. Clinically validated EP parameters were used and behavior of cell-to-cell junctions, in combination with leakage of 70 kDa fluorescein isothiocyanate labelled dextran (FD), was followed in time. After EP, a constriction of blood vessels was observed and correlated with the change in the shape of ECs. This was followed by an increase in permeability of blood vessels for 70 kDa FD and a decrease in the volume of labelled cell-to-cell junctions. Both parameters returned to pre-treatment values in 50% of mice. For the remaining 50%, we hypothesize that disruption of cell-to-cell junctions after EP may trigger the platelet activation cascade. Our findings show for the first time in vivo that alterations in cell-to-cell junctions play an important role in the response of blood vessels to EP and explain their efficient permeabilization.
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Affiliation(s)
- Bostjan Markelc
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France; Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Elisabeth Bellard
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Tanja Jesenko
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Sandrine Pelofy
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France
| | - Justin Teissié
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France
| | - Robert Frangez
- Institute of Preclinical Sciences, Veterinary Faculty, University of Ljubljana, Gerbiceva 60, SI-1000 Ljubljana, Slovenia
| | - Marie-Pierre Rols
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia; University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia.
| | - Muriel Golzio
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, BP 64182, 205 Route de Narbonne, F-31077, France.
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Semenov I, Zemlin C, Pakhomova ON, Xiao S, Pakhomov AG. Diffuse, non-polar electropermeabilization and reduced propidium uptake distinguish the effect of nanosecond electric pulses. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2015; 1848:2118-25. [PMID: 26112464 DOI: 10.1016/j.bbamem.2015.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/31/2015] [Accepted: 06/15/2015] [Indexed: 12/11/2022]
Abstract
Ca2+ activation and membrane electroporation by 10-ns and 4-ms electric pulses (nsEP and msEP) were compared in rat embryonic cardiomyocytes. The lowest electric field which triggered Ca2+ transients was expectedly higher for nsEP (36 kV/cm) than for msEP (0.09 kV/cm) but the respective doses were similar (190 and 460 mJ/g). At higher intensities, both stimuli triggered prolonged firing in quiescent cells. An increase of basal Ca2+ level by >10 nM in cells with blocked voltage-gated Ca2+ channels and depleted Ca2+ depot occurred at 63 kV/cm (nsEP) or 0.14 kV/cm (msEP) and was regarded as electroporation threshold. These electric field values were at 150-230% of stimulation thresholds for both msEP and nsEP, notwithstanding a 400,000-fold difference in pulse duration. For comparable levels of electroporative Ca2+ uptake, msEP caused at least 10-fold greater uptake of propidium than nsEP, suggesting increased yield of larger pores. Electroporation by msEP started Ca2+ entry abruptly and locally at the electrode-facing poles of cell, followed by a slow diffusion to the center. In a stark contrast, nsEP evoked a "supra-electroporation" pattern of slower but spatially uniform Ca2+ entry. Thus nsEP and msEP had comparable dose efficiency, but differed profoundly in the size and localization of electropores.
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Affiliation(s)
- Iurii Semenov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA
| | - Christian Zemlin
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA; Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA 23508, USA
| | - Olga N Pakhomova
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA
| | - Shu Xiao
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA; Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA 23508, USA
| | - Andrei G Pakhomov
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA 23508, USA.
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Biophotonic Modelling of Cardiac Optical Imaging. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 859:367-404. [DOI: 10.1007/978-3-319-17641-3_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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A comprehensive multiscale framework for simulating optogenetics in the heart. Nat Commun 2014; 4:2370. [PMID: 23982300 PMCID: PMC3838435 DOI: 10.1038/ncomms3370] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/26/2013] [Indexed: 02/05/2023] Open
Abstract
Optogenetics has emerged as an alternative method for electrical control of the heart, where illumination is used to elicit a bioelectric response in tissue modified to express photosensitive proteins (opsins). This technology promises to enable evocation of spatiotemporally precise responses in targeted cells or tissues, thus creating new possibilities for safe and effective therapeutic approaches to ameliorate cardiac function. Here, we present a comprehensive framework for multi-scale modelling of cardiac optogenetics, allowing both mechanistic examination of optical control and exploration of potential therapeutic applications. The framework incorporates accurate representations of opsin channel kinetics and delivery modes, spatial distribution of photosensitive cells, and tissue illumination constraints, making possible the prediction of emergent behaviour resulting from interactions at sub-organ scales. We apply this framework to explore how optogenetic delivery characteristics determine energy requirements for optical stimulation and to identify cardiac structures that are potential pacemaking targets with low optical excitation threshold.
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Can I, Tholakanahalli V. “Atrial torsades de pointes” Induced by Low-Energy Shock From Implantable-Cardioverter Defibrillator. Indian Pacing Electrophysiol J 2013; 13:194-9. [PMID: 24130431 PMCID: PMC3775325 DOI: 10.1016/s0972-6292(16)30674-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A 58 year-old-patient developed an episode of polymorphic atrial tachycardia which looked like "atrial torsades de pointes" after a 5J shock from implantable cardioverter defibrillator.
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Alternating current for defibrillation therapy: Time for reconsideration? Heart Rhythm 2013; 10:749-50. [DOI: 10.1016/j.hrthm.2013.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Indexed: 11/30/2022]
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37
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Rantner LJ, Tice BM, Trayanova NA. Terminating ventricular tachyarrhythmias using far-field low-voltage stimuli: mechanisms and delivery protocols. Heart Rhythm 2013; 10:1209-17. [PMID: 23628521 DOI: 10.1016/j.hrthm.2013.04.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Low-voltage termination of ventricular tachycardia (VT) and atrial fibrillation has shown promising results; however, the mechanisms and full range of applications remain unexplored. OBJECTIVES To elucidate the mechanisms for low-voltage cardioversion and defibrillation and to develop an optimal low-voltage defibrillation protocol. METHODS We developed a detailed magnetic resonance imaging-based computational model of the rabbit right ventricular wall. We applied multiple low-voltage far-field stimuli of various strengths (≤1 V/cm) and stimulation rates in VT and ventricular fibrillation (VF). RESULTS Of the 5 stimulation rates tested, stimuli applied at 16% or 88% of the VT cycle length (CL) were most effective in cardioverting VT, the mechanism being consecutive excitable gap decreases. Stimuli given at 88% of the VF CL defibrillated successfully, whereas a faster stimulation rate (16%) often failed because the fast stimuli did not capture enough tissue. In this model, defibrillation threshold energy for multiple low-voltage stimuli at 88% of VF CL was 0.58% of the defibrillation threshold energy for a single strong biphasic shock. Based on the simulation results, a novel 2-stage defibrillation protocol was proposed. The first stage converted VF into VT by applying low-voltage stimuli at times of maximal excitable gap, capturing large tissue volume and synchronizing depolarization; the second stage terminated VT. The energy required for successful defibrillation using this protocol was 57.42% of the energy for low-voltage defibrillation when stimulating at 88% of VF CL. CONCLUSIONS A novel 2-stage low-voltage defibrillation protocol using the excitable gap extent to time multiple stimuli defibrillated VF with the least energy by first converting VF into VT and then terminating VT.
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Affiliation(s)
- Lukas J Rantner
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Huang J, Walcott GP, Ruse RB, Bohanan SJ, Killingsworth CR, Ideker RE. Ascending-ramp biphasic waveform has a lower defibrillation threshold and releases less troponin I than a truncated exponential biphasic waveform. Circulation 2012; 126:1328-33. [PMID: 22865891 DOI: 10.1161/circulationaha.112.109777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We tested the hypothesis that the shape of the shock waveform affects not only the defibrillation threshold but also the amount of cardiac damage. METHODS AND RESULTS Defibrillation thresholds were determined for 11 waveforms-3 ascending-ramp waveforms, 3 descending-ramp waveforms, 3 rectilinear first-phase biphasic waveforms, a Gurvich waveform, and a truncated exponential biphasic waveform-in 6 pigs with electrodes in the right ventricular apex and superior vena cava. The ascending, descending, and rectilinear waveforms had 4-, 8-, and 16-millisecond first phases and a 3.5-millisecond rectilinear second phase that was half the voltage of the first phase. The exponential biphasic waveform had a 60% first-phase and a 50% second-phase tilt. In a second study, we attempted to defibrillate after 10 seconds of ventricular fibrillation with a single ≈30-J shock (6 pigs successfully defibrillated with 8-millisecond ascending, 8-millisecond rectilinear, and truncated exponential biphasic waveforms). Troponin I blood levels were determined before and 2 to 10 hours after the shock. The lowest-energy defibrillation threshold was for the 8-milliseconds ascending ramp (14.6±7.3 J [mean±SD]), which was significantly less than for the truncated exponential (19.6±6.3 J). Six hours after shock, troponin I was significantly less for the ascending-ramp waveform (0.80±0.54 ng/mL) than for the truncated exponential (1.92±0.47 ng/mL) or the rectilinear waveform (1.17±0.45 ng/mL). CONCLUSIONS The ascending ramp has a significantly lower defibrillation threshold and at ≈30 J causes 58% less troponin I release than the truncated exponential biphasic shock. Therefore, the shock waveform affects both the defibrillation threshold and the amount of cardiac damage.
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Affiliation(s)
- Jian Huang
- University of Alabama-Birmingham, 1670 University Blvd, Room B140 Volker Hall, Birmingham, AL 35294-0019, USA.
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Wang YT, Efimov IR, Cheng Y. Electroporation induced by internal defibrillation shock with and without recovery in intact rabbit hearts. Am J Physiol Heart Circ Physiol 2012; 303:H439-49. [PMID: 22730387 DOI: 10.1152/ajpheart.01121.2011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Defibrillation shocks from implantable cardioverter defibrillators can be lifesaving but can also damage cardiac tissues via electroporation. This study characterizes the spatial distribution and extent of defibrillation shock-induced electroporation with and without a 45-min postshock period for cell membranes to recover. Langendorff-perfused rabbit hearts (n = 31) with and without a chronic left ventricular (LV) myocardial infarction (MI) were studied. Mean defibrillation threshold (DFT) was determined to be 161.4 ± 17.1 V and 1.65 ± 0.44 J in MI hearts for internally delivered 8-ms monophasic truncated exponential (MTE) shocks during sustained ventricular fibrillation (>20 s, SVF). A single 300-V MTE shock (twice determined DFT voltage) was used to terminate SVF. Shock-induced electroporation was assessed by propidium iodide (PI) uptake. Ventricular PI staining was quantified by fluorescent imaging. Histological analysis was performed using Masson's Trichrome staining. Results showed PI staining concentrated near the shock electrode in all hearts. Without recovery, PI staining was similar between normal and MI groups around the shock electrode and over the whole ventricles. However, MI hearts had greater total PI uptake in anterior (P < 0.01) and posterior (P < 0.01) LV epicardial regions. Postrecovery, PI staining was reduced substantially, but residual staining remained significant with similar spacial distributions. PI staining under SVF was similar to previously studied paced hearts. In conclusion, electroporation was spatially correlated with the active region of the shock electrode. Additional electroporation occurred in the LV epicardium of MI hearts, in the infarct border zone. Recovery of membrane integrity postelectroporation is likely a prolonged process. Short periods of SVF did not affect electroporation injury.
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Affiliation(s)
- Yves T Wang
- Department of Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
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Rantner LJ, Arevalo HJ, Constantino JL, Efimov IR, Plank G, Trayanova NA. Three-dimensional mechanisms of increased vulnerability to electric shocks in myocardial infarction: altered virtual electrode polarizations and conduction delay in the peri-infarct zone. J Physiol 2012; 590:4537-51. [PMID: 22586222 DOI: 10.1113/jphysiol.2012.229088] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Defibrillation efficacy is decreased in infarcted hearts, but the mechanisms by which infarcted hearts are more vulnerable to electric shocks than healthy hearts remain poorly understood. The goal of this study was to provide insight into the 3D mechanisms for the increased vulnerability to electric shocks in infarcted hearts. We hypothesized that changes in virtual electrode polarizations (VEPs) and propagation delay through the peri-infarct zone (PZ) were responsible. We developed a micro anatomically detailed rabbit ventricular model with chronic myocardial infarction from magnetic resonance imaging and enriched the model with data from optical mapping experiments. We further developed a control model without the infarct. The simulation protocol involved apical pacing followed by biphasic shocks. Simulation results from both models were compared.The upper limit of vulnerability(ULV) was 8 V cm(-1) in the infarction model and 4 V cm(-1) in the control model. VEPs were less pronounced in the infarction model, providing a larger excitable area for postshock propagation but smaller transmembrane potential gradients to initiate new wavefronts. Initial post-shock transmural activation occurred at a later time in the infarction model, and the PZ served to delay propagation in subsequent beats. The presence of the PZ was found to be responsible for the increased vulnerability.
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Affiliation(s)
- Lukas J Rantner
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
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Tandri H, Weinberg SH, Chang KC, Zhu R, Trayanova NA, Tung L, Berger RD. Reversible cardiac conduction block and defibrillation with high-frequency electric field. Sci Transl Med 2012; 3:102ra96. [PMID: 21957174 DOI: 10.1126/scitranslmed.3002445] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Electrical impulse propagation is an essential function in cardiac, skeletal muscle, and nervous tissue. Abnormalities in cardiac impulse propagation underlie lethal reentrant arrhythmias, including ventricular fibrillation. Temporary propagation block throughout the ventricular myocardium could possibly terminate these arrhythmias. Electrical stimulation has been applied to nervous tissue to cause reversible conduction block, but has not been explored sufficiently in cardiac tissue. We show that reversible propagation block can be achieved in cardiac tissue by holding myocardial cells in a refractory state for a designated period of time by applying a sustained sinusoidal high-frequency alternating current (HFAC); in doing so, reentrant arrhythmias are terminated. We demonstrate proof of concept using several models, including optically mapped monolayers of neonatal rat ventricular cardiomyocytes, Langendorff-perfused guinea pig and rabbit hearts, intact anesthetized adult rabbits, and computer simulations of whole-heart impulse propagation. HFAC may be an effective and potentially safer alternative to direct current application, currently used to treat ventricular fibrillation.
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Affiliation(s)
- Harikrishna Tandri
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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Shock-induced focal arrhythmias: not driven by calcium? Heart Rhythm 2011; 9:105-6. [PMID: 22079556 DOI: 10.1016/j.hrthm.2011.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Indexed: 11/23/2022]
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Li W, Janardhan AH, Fedorov VV, Sha Q, Schuessler RB, Efimov IR. Low-energy multistage atrial defibrillation therapy terminates atrial fibrillation with less energy than a single shock. Circ Arrhythm Electrophysiol 2011; 4:917-25. [PMID: 21980076 DOI: 10.1161/circep.111.965830] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable device therapy of atrial fibrillation (AF) is limited by pain from high-energy shocks. We developed a low-energy multistage defibrillation therapy and tested it in a canine model of AF. METHODS AND RESULTS AF was induced by burst pacing during vagus nerve stimulation. Our novel defibrillation therapy consisted of 3 stages: stage (ST) 1 (1-4 low-energy biphasic [BP] shocks), ST2 (6-10 ultralow-energy monophasic [MP] shocks), and ST3 (antitachycardia pacing). First, ST1 testing compared single or multiple MP and BP shocks. Second, several multistage therapies were tested: ST1 versus ST1+ST3 versus ST1+ST2+ST3. Third, 3 shock vectors were compared: superior vena cava to distal coronary sinus, proximal coronary sinus to left atrial appendage, and right atrial appendage to left atrial appendage. The atrial defibrillation threshold (DFT) of 1 BP shock was <1 MP shock (0.55 ± 0.1 versus 1.38 ± 0.31 J, P=0.003). Two to 3 BP shocks terminated AF with lower peak voltage than 1 BP or 1 MP shock and with lower atrial DFT than 4 BP shocks. Compared with ST1 therapy alone, ST1+ST3 lowered the atrial DFT moderately (0.51 ± 0.46 versus 0.95 ± 0.32 J, P=0.036), whereas 3-stage therapy (ST1+ST2+ST3) dramatically lowered the atrial DFT (0.19 ± 0.12 versus 0.95 ± 0.32 J for ST1 alone, P=0.0012). Finally, the 3-stage therapy was equally effective for all studied vectors. CONCLUSIONS Three-stage electrotherapy significantly reduces the AF DFT and opens the door to low-energy atrial defibrillation at or below the pain threshold.
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Affiliation(s)
- Wenwen Li
- Department of Biomedical Engineering, Washington University School of Medicine, St Louis, MO 63130, USA
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Irreversible electroporation near the heart: ventricular arrhythmias can be prevented with ECG synchronization. AJR Am J Roentgenol 2011; 196:W330-5. [PMID: 21343484 DOI: 10.2214/ajr.10.4490] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Irreversible electroporation is a nonthermal ablative tool that uses direct electrical pulses to create irreversible membrane pores and cell death. The ablation zone is surrounded by a zone of reversibly increased permeability; either zone can cause cardiac arrhythmias. Our purpose was to establish a safety profile for the use of irreversible electroporation close to the heart. MATERIALS AND METHODS The effect of unsynchronized and synchronized (with the R wave on ECG) irreversible electroporation in swine lung and myocardium was studied in 11 pigs. Twelve lead ECG recordings were analyzed by an electrophysiologist for the presence of arrhythmia. Ventricular arrhythmias were categorized as major events. Minor events included all other dysrhythmias or ECG changes. Cardiac and lung tissue was submitted for histopathologic analysis. Electrical field modeling was performed to predict the distance from the applicators over which cells show electroporation-induced increased permeability. RESULTS At less than or equal to 1.7 cm from the heart, fatal (major) events occurred with all unsynchronized irreversible electroporation. No major and three minor events were seen with synchronized irreversible electroporation. At more than 1.7 cm from the heart, two minor events occurred with only unsynchronized irreversible electroporation. Electrical field modeling correlates well with the clinical results, revealing increased cell membrane permeability up to 1.7 cm away from the applicators. Complete lung ablation without intervening live cells was seen. No myocardial injury was seen. CONCLUSION Unsynchronized irreversible electroporation close to the heart can cause fatal ventricular arrhythmias. Synchronizing irreversible electroporation pulse delivery with absolute refractory period avoids significant cardiac arrhythmias.
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LAWO THOMAS, SCHRADER JÜRGEN, BUDDENSIEK MICHAEL, SCHWEIKA OLIVER, MÜGGE ANDREAS, BÖSCHE LEIFI. Termination of Ventricular Tachycardia by Far-Field Stimulation in Humans: A Feasibility Study. Pacing Clin Electrophysiol 2010; 33:1540-7. [DOI: 10.1111/j.1540-8159.2010.02891.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dyachok O, Zhabyeyev P, McDonald TF. Electroporation-induced inward current in voltage-clamped guinea pig ventricular myocytes. J Membr Biol 2010; 238:69-80. [PMID: 21104181 DOI: 10.1007/s00232-010-9320-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/29/2010] [Indexed: 01/29/2023]
Abstract
Electroporation induced by high-strength electrical fields has long been used to investigate membrane properties and facilitate transmembrane delivery of molecules and genes for research and clinical purposes. In the heart, electric field-induced passage of ions through electropores is a factor in defibrillation and postshock dysfunction. Voltage-clamp pulses can also induce electroporation, as exemplified by findings in earlier studies on rabbit ventricular myocytes: Long hyperpolarizations to ≤-110 mV induced influx of marker ethidium and irregular inward currents that were as large with external NMDG(+) as Na(+). In the present study, guinea pig ventricular myocytes were bathed with NMDG(+), Na(+) or NMDG(+) + La(3+) solution (36°C) and treated with five channel blockers. Hyperpolarization of myocytes in NMDG(+) solution elicited an irregular inward current (I (ep)) that reversed at -21.5 ± 1.5 mV. In myocytes hyperpolarized with 200-ms steps every 30 s, I (ep) occurred in "episodes" that lasted for one to four steps. Boltzmann fits to data on the incidence of I (ep) per experiment indicate 50% incidence at -129.7 ± 1.4 mV (Na(+)) and -146.3 ± 1.6 mV (NMDG(+)) (slopes ≈-7.5 mV). I (ep) amplitude increased with negative voltage and was larger with Na(+) than NMDG(+) (e.g., -2.83 ± 0.34 vs. -1.40 ± 0.22 nA at -190 mV). La(3+) (0.2 mM) shortened episodes, shifted 50% incidence by -35 mV and decreased amplitude, suggesting that it inhibits opening/promotes closing of electropores. We compare our findings with earlier ones, especially in regard to electropore selectivity. In the Appendix, relative permeabilities and modified excluded-area theory are used to derive estimates of electropore diameters consistent with reversal potential -21.5 mV.
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Affiliation(s)
- Oksana Dyachok
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, B3H 1X5, Canada
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Stempniewicz P, Cheng A, Connolly A, Wang XY, Calkins H, Tomaselli GF, Berger RD, Tereshchenko LG. Appropriate and inappropriate electrical therapies delivered by an implantable cardioverter-defibrillator: effect on intracardiac electrogram. J Cardiovasc Electrophysiol 2010; 22:554-60. [PMID: 21087331 DOI: 10.1111/j.1540-8167.2010.01958.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Local injury current (LIC) seen after induced ventricular fibrillation rescue implantable cardioverter-defibrillator (ICD) shock predicts heart failure progression. We sought to determine the frequency of LIC after spontaneous events in patients receiving ICD therapies. METHODS AND RESULTS Near-field (NF) right ventricular (RV) EGM during 10 seconds after delivered ICD therapy was compared with baseline EGM in 420 events that occurred in 134 patients (mean age 60.8 ± 14.8, 106 [79%] male). The magnitude of elevated or depressed potential immediately after the major fast EGM deflection was defined as LIC, and its ratio to the peak-to-peak EGM amplitude was defined as relative LIC. LIC of at least 1 mV or relative LIC of at least 15% was considered significant. LIC was observed in 121 events (28.8%) and was detected more frequently after appropriate (43 [60.6%] events) and inappropriate (56 [64.4%] events) ICD shocks, as compared with appropriate (8 [9.2%] events) and inappropriate (3 [4.7%] events) antitachycardia pacing (ATP) or nonsustained ventricular tachycardia (11 [9.9%] events) [ANOVA P < 0.0001]. Type of ICD therapy (ICD shock vs ATP) was the most significant predictor of LIC (ATP β coefficient -0.81; 95%CI-1.19 to 0.44); P < 0.0001), along with cycle length of tachycardia (β coefficient -0.0117; 95%CI -0.0167 to -0.0068, P < 0.00001) and shock energy (β coefficient 0.024; 95%CI 0.003-0.045, P = 0.025). CONCLUSION Appropriate and inappropriate ICD shocks are frequently characterized by the development of LIC in patients with structural heart disease. Type of electrical ICD therapy, shock energy and cycle length of ventricular arrhythmia are important determinants of LIC.
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Affiliation(s)
- Peter Stempniewicz
- Whiting School of Engineering, The Johns Hopkins University, Baltimore, Maryland, USA
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Chernysh AM, Kozlova EK, Moroz VV, Borshagovskaya PY, Bliznuk UA, Rysaeva RM. Erythrocyte Membrane Surface after Calibrated Electroporation: Visualization by Atomic Force Microscopy. Bull Exp Biol Med 2010; 148:455-60. [DOI: 10.1007/s10517-010-0735-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gissel H. Effects of varying pulse parameters on ion homeostasis, cellular integrity, and force following electroporation of rat muscle in vivo. Am J Physiol Regul Integr Comp Physiol 2010; 298:R918-29. [PMID: 20106990 DOI: 10.1152/ajpregu.00692.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Electroporation is a technique used in vitro, ex vivo, and in vivo to permeabilize cell membranes. The effect on the tissue describes a continuum ranging from mild perturbations to massive tissue damage. Thus care should be taken when choosing pulses for a given application. Here the effects of electroporation paradigms ranging from severe to very gentle permeabilization were investigated on soleus, mainly composed of slow-twitch fibers, and extensor digitorum longus (EDL) and tibialis anterior (TA), almost exclusively composed of fast-twitch fibers. Five key physiological parameters were studied: force, muscle Na(+), K(+), and Ca(2+) content, and plasma lactate dehydrogenase activity. Four-week-old Wistar rats were anesthetized, and the lower part of the hind leg was electroporated. Blood samples were collected from the tail vein, and at the times indicated animals were killed and TA, EDL, and soleus muscles were collected for analysis of force and ion contents. Muscles were given eight high-voltage pulses of 100-mus duration (8HV) at varying field intensity, one short high-voltage pulse combined with one long low-voltage pulse (HVLV), or eight medium-voltage pulses of 20-ms duration (8MV). Intensity of the electrical field strength was determinant for the degree of changes observed in the muscle. Field strengths below 300 V/cm did not give rise to measurable changes, whereas 8HV pulses at high field intensities (1,200 V/cm) caused severe and long-lasting damage to the muscle. Interestingly, the damage was more pronounced in EDL and TA compared with soleus, possibly because of the difference in fiber type composition. HVLV only caused temporary changes, with force and ion content being normalized by 4 h, suggesting that this pulse combination may be useful for the introduction of ions and molecules (e.g., DNA) into muscle cells.
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Affiliation(s)
- Hanne Gissel
- Department of Physiology and Biophysics, Ole Worms Allé 1160, DK-8000 Arhus C, Denmark.
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Tissue Electroporation as a Bioelectric Phenomenon: Basic Concepts. IRREVERSIBLE ELECTROPORATION 2010. [DOI: 10.1007/978-3-642-05420-4_2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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