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Narkar A, Kaboudian A, Ardershirpour Y, Casciola M, Feaster TK, Blinova K. In Vitro Assay Development to Study Pulse Field Ablation Outcome Using Solanum Tuberosum. Int J Mol Sci 2024; 25:8967. [PMID: 39201653 PMCID: PMC11354718 DOI: 10.3390/ijms25168967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Exposing cells to intense and brief electric field pulses can modulate cell permeability, a phenomenon termed electroporation. When applied in medical treatments of diseases like cancer and cardiac arrhythmias, depending on level of cellular destruction, it is also referred to as irreversible electroporation (IRE) or Pulsed Field Ablation (PFA). For ablation device testing, several pulse parameters need to be characterized in a comprehensive manner to assess lesion boundary and efficacy. Overly aggressive voltages and application numbers increase animal burden. The potato tuber is a widely used initial model for the early testing of electroporation. The aim of this study is to characterize and refine bench testing for the ablation outcomes of PFA in this simplistic vegetal model. For in vitro assays, several pulse parameters like voltage, duration, and frequency were modulated to study effects not only on 2D ablation area but also 3D depth and volume. As PFA is a relatively new technology with minimal thermal effects, we also measured temperature changes before, during, and after ablation. Data from experiments were supplemented with in silico modeling to examine E-field distribution. We have estimated the irreversible electroporation threshold in Solanum Tuberosum to be at 240 V/cm. This bench testing platform can screen several pulse recipes at early stages of PFA device development in a rapid and high-throughput manner before proceeding to laborious trials for IRE medical devices.
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Affiliation(s)
- Akshay Narkar
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
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Kautzner J, Hašková J, Cvek J, Adamíra M, Peichl P. Hypertrophic obstructive cardiomyopathy with recurrent ventricular tachycardias: from catheter ablation and stereotactic radiotherapy to heart transplant-a case report. Eur Heart J Case Rep 2024; 8:ytae379. [PMID: 39144539 PMCID: PMC11322737 DOI: 10.1093/ehjcr/ytae379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/15/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024]
Abstract
Background Management of hypertrophic obstructive cardiomyopathy (HOCM) is often challenging, depending on clinical manifestation. This case report illustrates the complex treatment of HOCM with associated recurrent ventricular arrhythmias. Case summary A 54-year-old female with HOCM diagnosed in 2012 underwent a failed attempt for alcohol septal ablation, implantation of an implantable cardioverter-defibrillator, and repeated radiofrequency ablations (including ablation of the septal bulge to reduce LV obstruction). For ventricular tachycardia (VT) recurrences, she had stereotactic arrhythmia radioablation with subsequent epicardial cryoablation from mini-thoracotomy, and endocardial ablation with pulsed field energy. The situation was finally solved by mechanical support and heart transplantation. Discussion A few important lessons can be learned from the case. First, radiofrequency ablation was used successfully to decrease left outflow tract obstruction. Second, stereotactic radiotherapy has been used after four previous endo/epicardial catheter ablations to decrease the recurrences of VT. Third, mini-thoracotomy was used after previous epicardial ablation with subsequent adhesions to modify the epicardial substrate with cryoenergy. Fourth, pulsed field ablation of atrial fibrillation resulted in an excellent therapeutic effect. Fifth, pulsed field ablation was also used to modify the substrate for VT, and was complicated by transient AV block with haemodynamic deterioration requiring mechanical support. Finally, a heart transplant was the ultimate solution in the management of recurrent VT.
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Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14300 Prague 4, Czech Republic
- Department of Medicine 1, Palacky University Medical School, Palacky University Medical School Hospital, Zdravotníků 248/7, 77900 Olomouc, Czech Republic
| | - Jana Hašková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14300 Prague 4, Czech Republic
- Department of Medicine 1, Palacky University Medical School, Palacky University Medical School Hospital, Zdravotníků 248/7, 77900 Olomouc, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava and Ostrava University Medical School, 17. listopadu 1790/5, 70800 Ostrava, Czech Republic
| | - Marek Adamíra
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14300 Prague 4, Czech Republic
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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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Nies M, Watanabe K, Kawamura I, Wang BJ, Litt J, Turovskiy R, Danitz DJ, Uecker DR, Linder KE, Maejima Y, Sasano T, Reddy VY, Koruth JS. Ablating Myocardium Using Nanosecond Pulsed Electric Fields: Preclinical Assessment of Feasibility, Safety, and Durability. Circ Arrhythm Electrophysiol 2024; 17:e012854. [PMID: 38758741 PMCID: PMC11254255 DOI: 10.1161/circep.124.012854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/17/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Unlike conventional microsecond pulsed electrical fields that primarily target the cell membranes, nanosecond pulses are thought to primarily electroporate intracellular organelles. We conducted a comprehensive preclinical assessment of catheter-based endocardial nanosecond pulsed field ablation in swine. METHODS A novel endocardial nanosecond pulsed field ablation system was evaluated in a total of 25 swine. Using either a low-dose (5-second duration) or high-dose (15-second duration) strategy, thoracic veins and discrete atrial and ventricular sites were ablated. Predetermined survival periods were <1 (n=1), ≈2 (n=7), ≈7 (n=6), 14 (n=2), or ≈28 (n=9) days, and venous isolation was assessed before euthanasia. Safety assessments included evaluation of esophageal effects, phrenic nerve function, and changes in venous caliber. All tissues were subject to careful gross pathological and histopathologic examination. RESULTS All (100%) veins (13 low-dose, 34 high-dose) were acutely isolated, and all reassessed veins (6 low-dose, 15 high-dose) were durably isolated. All examined vein lesions (10 low-dose, 22 high-dose) were transmural. Vein diameters (n=15) were not significantly changed. Of the animals assessed for phrenic palsy (n=9), 3 (33%) demonstrated only transient palsy. There were no differences between dosing strategies. Thirteen mitral isthmus lesions were analyzed, and all 13 (100%) were transmural (depth, 6.4±0.4 mm). Ventricular lesions were 14.7±4.5 mm wide and 7.1±1.3 mm deep, with high-dose lesions deeper than low-dose (7.9±1.2 versus 6.2±0.8 mm; P=0.007). The esophagus revealed nontransmural adventitial surface lesions in 5 of 5 (100%) animals euthanized early (2 days) post-ablation. In the 10 animals euthanized later (14-28 days), all animals demonstrated significant esophageal healing-8 with complete resolution, and 2 with only trace fibrosis. CONCLUSIONS A novel, endocardial nanosecond pulsed field ablation system provides acute and durable venous isolation and linear lesions. Transient phrenic injury and nontransmural esophageal lesions can occur with worst-case assessments suggesting limits to pulsed field ablation tissue selectivity and the need for dedicated assessments during clinical studies.
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Affiliation(s)
- Moritz Nies
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Germany (M.N.)
| | - Keita Watanabe
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
| | - Bingyan J. Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York (B.J.W.)
| | - Jeffrey Litt
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - Roman Turovskiy
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - David J. Danitz
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | - Darrin R. Uecker
- Pulse Biosciences, Inc., Hayward, CA (J.L., R.T., D.J.D., D.R.U.)
| | | | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers and New Jersey Medical School, Newark (Y.M.)
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (I.K., Y.M., T.S.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.), Icahn School of Medicine at Mount Sinai, New York
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Nies M, Watanabe K, Kawamura I, Santos-Gallego CG, Reddy VY, Koruth JS. Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall. Circ Arrhythm Electrophysiol 2024; 17:e012734. [PMID: 38753535 PMCID: PMC11186713 DOI: 10.1161/circep.124.012734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue. METHODS A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall. RESULTS (1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions. CONCLUSIONS This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.
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Affiliation(s)
- Moritz Nies
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.)
| | - Keita Watanabe
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Carlos G. Santos-Gallego
- Atherothrombosis Research Unit, Icahn School of Medicine at Mount Sinai, New York, NY (C.G.S.-G.)
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (M.N., K.W., I.K., V.Y.R., J.S.K.)
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Hindricks G, Tscholl V, Dagres N, Attanasio P, Huemer M. [Development of catheter ablation of supraventricular tachycardias with special consideration of contributions from German engineers and electrophysiologists]. Herzschrittmacherther Elektrophysiol 2024; 35:110-117. [PMID: 38416159 PMCID: PMC10923970 DOI: 10.1007/s00399-024-01009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
The development and clinical implementation of catheter ablation of supraventricular tachycardia is one of the outstanding achievements of modern cardiovascular treatment. Over a period of less than 40 years, a curative and safe treatment strategy for almost all forms of atrial arrhythmias has been developed and implemented. German electrophysiologists and engineers have made a significant contribution to this truly outstanding success story in modern medicine. Their contributions should be appropriately acknowledged because without them, the development of ablation technology and its worldwide dissemination would not have been possible. Both the technological contributions and the medical-electrophysiological contributions were at the absolute forefront of worldwide developments and have made a significant contribution to the fact that today more than 500,000 patients with symptomatic and/or threatening cardiac arrhythmias can be successfully treated every year by use of catheter ablation. We would like to thank them all for their achievements.
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Affiliation(s)
- Gerhard Hindricks
- Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, DE, Deutschland.
| | - Verena Tscholl
- Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, DE, Deutschland
| | - Nikolaos Dagres
- Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, DE, Deutschland
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, DE, Deutschland
| | - Martin Huemer
- Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, DE, Deutschland
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Chinyere IR, Mori S, Hutchinson MD. Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation. VESSEL PLUS 2024; 8:7. [PMID: 38646143 PMCID: PMC11027649 DOI: 10.20517/2574-1209.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA's effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.
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Affiliation(s)
- Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Mathew D. Hutchinson
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
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Repp ML, Chinyere IR. Opportunities and Challenges in Catheter-Based Irreversible Electroporation for Ventricular Tachycardia. PATHOPHYSIOLOGY 2024; 31:32-43. [PMID: 38251047 PMCID: PMC10801500 DOI: 10.3390/pathophysiology31010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The use of catheter-based irreversible electroporation in clinical cardiac laboratories, termed pulsed-field ablation (PFA), is gaining international momentum among cardiac electrophysiology proceduralists for the non-thermal management of both atrial and ventricular tachyrhythmogenic substrates. One area of potential application for PFA is in the mitigation of ventricular tachycardia (VT) risk in the setting of ischemia-mediated myocardial fibrosis, as evidenced by recently published clinical case reports. The efficacy of tissue electroporation has been documented in other branches of science and medicine; however, ventricular PFA's potential advantages and pitfalls are less understood. This comprehensive review will briefly summarize the pathophysiological mechanisms underlying VT and then summarize the pre-clinical and adult clinical data published to date on PFA's effectiveness in treating monomorphic VT. These data will be contrasted with the effectiveness ascribed to thermal cardiac ablation modalities to treat VT, namely radiofrequency energy and liquid nitrogen-based cryoablation.
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Affiliation(s)
| | - Ikeotunye Royal Chinyere
- Department of Medecine, Banner University Medicine, Tucson, AZ 85724, USA
- Sarver Heart Center, University of Arizona, 1501 North Campbell Avenue, Room 6154, Tucson, AZ 85724, USA
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Garcia Garcia J, Arya A, Dinov B, Bollmann A, ter Bekke RMA, Vernooy K, Dagres N, Hindricks G, Darma A. Impact of repeat ablation of ventricular tachycardia in patients with structural heart disease. Europace 2023; 26:euad367. [PMID: 38127308 PMCID: PMC10755192 DOI: 10.1093/europace/euad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. In this study, we report the efficacy and risks of repeat VT ablation in patients with structural heart disease (SHD) in a tertiary single centre over a 7-year period. METHODS AND RESULTS Two hundred ten consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischaemic cardiomyopathy, 91% males, median age 65 years, mean left ventricular ejection fraction 35%). After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. Fifty-two patients (25%) reached the combined endpoint of ventricular assist device implantation, heart transplantation, or death. Advanced New York Heart Association functional class, anteroseptal substrate, and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy. CONCLUSION While complete freedom from VT after repeat ablation in SHD was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.
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Affiliation(s)
- Joaquin Garcia Garcia
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Halle University, Halle (Saale), Germany
| | - Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
| | - Rachel M A ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Angeliki Darma
- Department of Cardiac Electrophysiology, Heart Center of Leipzig, Struempellstrasse 39, Leipzig 04289, Germany
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Adragão P, Matos D, Carmo P, Costa FM, Ramos S. Pulsed-field ablation vs radiofrequency ablation for ventricular tachycardia: First in-human case of histologic lesion analysis. Heart Rhythm 2023; 20:1395-1398. [PMID: 37488032 DOI: 10.1016/j.hrthm.2023.07.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Pedro Adragão
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Daniel Matos
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal.
| | - Pedro Carmo
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Francisco Moscoso Costa
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Sância Ramos
- Cardiology and Electrophysiology Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
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Gunawardene MA, Frommeyer G, Ellermann C, Jularic M, Leitz P, Hartmann J, Lange PS, Anwar O, Rath B, Wahedi R, Eckardt L, Willems S. Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation. J Clin Med 2023; 12:6304. [PMID: 37834948 PMCID: PMC10573684 DOI: 10.3390/jcm12196304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. OBJECTIVE This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. METHODS Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. RESULTS In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62-95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. CONCLUSION LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option.
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Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 10178 Berlin, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Christian Ellermann
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Patrick Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Philipp Sebastian Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany; (C.E.)
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany
- Semmelweis University, 1082 Budapest, Hungary
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 10178 Berlin, Germany
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Affiliation(s)
- Jacob S Koruth
- Helmsely Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Iwanari Kawamura
- Helmsely Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Koruth JS, Nies M. Ventricular Pulsed-Field Ablation: Pushing for More or Pushing too Far? JACC Clin Electrophysiol 2023; 9:1995-1997. [PMID: 37498240 DOI: 10.1016/j.jacep.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Jacob S Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Moritz Nies
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Hansen J, Haugdal MA, Johannessen A, Hansen ML, Worck R, Ruwald MH. Focal pulsed field electroporation of left ventricular premature contractions after failed radiofrequency ablation. HeartRhythm Case Rep 2023; 9:581-585. [PMID: 37614400 PMCID: PMC10444564 DOI: 10.1016/j.hrcr.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Jim Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Martin A. Haugdal
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Arne Johannessen
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Morten Lock Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Rene Worck
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Martin H. Ruwald
- Division of Electrophysiology, Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
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