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Della Rocca DG, Cespón-Fernández M, Keelani A, Raffa S, Pannone L, Almorad A, Ströker E, Borisov G, Bala G, Sieira J, Vetta G, Alothman O, Sorgente A, Audiat C, Overeinder I, Frommhold M, Del Monte A, La Meir M, Natale A, Chierchia GB, Geller JC, de Asmundis C, Sarkozy A. Focal Pulsed Field Ablation for Premature Ventricular Contractions: A Multicenter Experience. Circ Arrhythm Electrophysiol 2024; 17:e012826. [PMID: 39234745 DOI: 10.1161/circep.124.012826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel technology for catheter-based atrial arrhythmia treatment. Evidence of its application for ventricular arrhythmia ablation is still limited. In this study, we describe the feasibility and efficacy of focal PFA for premature ventricular contraction (PVC) ablation. METHODS A prospective cohort of 20 patients referred for PVC ablation at 2 centers was enrolled, regardless of the presence of structural heart disease, PVC morphology, or previous ablation attempts. All procedures were performed using the CENTAURI System in combination with contact force sensing catheters and 3-dimensional electroanatomical mapping systems. Energy output and the number of applications were left to the operator's discretion. RESULTS Eleven (55%) procedures were conducted under general anesthesia, 6 (30%) under deep sedation, and 3 (15%) under light sedation. Muscular contraction was observed in one case (5%). Median procedural and fluoroscopy times were 95.5 and 6.55 minutes, respectively. The median number of PFA applications was 8 with a median contact force of 10g. A statistically significant (76%) reduction was observed in mean peak-to-peak bipolar electrogram voltage before and after ablation (0.707 versus 0.098 mV; P=0.008). Ventricular irritative firing was observed in 11 (55%) patients after PFA. The median follow-up was 120 days. Acute procedural success was achieved in 17 of 20 (85% [95% CI, 0.70-1]) patients. Two of the patients with procedural failure had late success with >80% clinical PVC burden suppression during follow-up, and 2 of 17 patients with acute success had late PVC recurrence, which accounts for a total of 17 of 20 (85% [95% CI, 0.70-1]) patients with chronic success. Transient ST-segment depression occurred in 1 patient, and the right bundle branch block was induced in 2 others (permanently only in one case). CONCLUSIONS PVC ablation using a focal PFA is feasible, effective, and safe, with promising acute and long-term results in several ventricular locations. Irritative firing is frequently observed. Coronary evaluation should be considered when targeting the outflow tract.
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Affiliation(s)
- Domenico Giovanni Della Rocca
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
| | - María Cespón-Fernández
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
- Galicia Sur Health Research Institute, Vigo, Spain (M.C.-F.)
| | - Ahmad Keelani
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Santi Raffa
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Luigi Pannone
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Georgi Borisov
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Giampaolo Vetta
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Obaida Alothman
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Charles Audiat
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Markus Frommhold
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
| | - Alvise Del Monte
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Belgium (M.L.M.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (D.G.D.R., A.N.)
- Division of Cardiology, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy (A.N.)
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - J Christoph Geller
- Division of Cardiology, Arrhythmia Section, Zentralklinik, Bad Berka, Germany (A.K., S.R., G. Borisov, O.A., M.F., J.C.G.)
- Faculty of Medicine, Otto-von-Guericke University Magdeburg, Germany (J.C.G.)
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R., M.C.-F., L.P., A.A., E.S., G. Bala, J.S., G.V., A. Sorgente, C.A., I.O., A.D.M., G.-B.C., C.d.A., A. Sarkozy)
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Wang Z, Liang M, Sun J, Zhang J, Li Y, Xu L, Han Y. Epicardial pulsed-field ablation-impact of electric field and heat distribution induced by coronary metallic stents. Front Cardiovasc Med 2024; 11:1445424. [PMID: 39267803 PMCID: PMC11391106 DOI: 10.3389/fcvm.2024.1445424] [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: 06/07/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Background Pulsed-field ablation (PFA) technique is a nonthermal ablation technique. No study has yet evaluated the effect of the positional relationship between the ablation electrode (AE) and the coronary metal stent (CMS) on the electric field distribution and temperature distribution in epicardial ablation. Our study aimed to evaluate the effect of the CMS on the electric field as well as the temperature distribution in different models. Methods Multi-angle modeling of the CMS and AE was performed. The PFA ablation region was evaluated with a field strength contour of 1,000 V/cm, which was used to assess the validity of the two-dimensional (2D) model simulation data as well as the distribution of the multi-angle electric field and temperature in the three-dimensional (3D) model. Results The presence of the CMS had little effect on the width of the ablation area (0.2 mm). In the 3D model, the temperature of the ablation area was highest when the angle between the AE and the CMS was in the 90° position (43.4°C, 41.3°C); a change in the distance between the AE and the CMS affected the temperature of the ablation area (maximum 2.1°C) and the width of the ablation (maximum 0.32 mm). Conclusion The presence of the CMS distorts the distribution of the electric field, but does not produce a change in the extent of the ablation damage, nor does it bring thermal damage to the ablation region. Different simulation models give similar results in PFA calculations, and this study effectively reduces the complexity of modeling simulation.
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Affiliation(s)
- Zhen Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, General Hospital of Northern Theater Command, Shenyang, China
| | - Jingyang Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jie Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yunhao Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Graduate School of China Medical University, China Medical University, Shenyang, China
| | - Lisheng Xu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, General Hospital of Northern Theater Command, Shenyang, China
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Casciola M, Kaboudian A, Feaster TK, Narkar A, Blinova K. Pulsed electric field performance calculator tool based on an in vitro human cardiac model. Front Physiol 2024; 15:1395923. [PMID: 38911328 PMCID: PMC11190366 DOI: 10.3389/fphys.2024.1395923] [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: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Pulsed Field Ablation (PFA) is a novel non-thermal method for cardiac ablation, relying on irreversible electroporation induced by high-energy pulsed electric fields (PEFs) to create localized lesions in the heart atria. A significant challenge in optimizing PFA treatments is determining the lethal electric field threshold (EFT), which governs ablation volume and varies with PEF waveform parameters. However, the proprietary nature of device developer's waveform characteristics and the lack of standardized nonclinical testing methods have left optimal EFTs for cardiac ablation uncertain. Methods To address this gap, we introduced a laboratory protocol employing human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in monolayer format to evaluate the impact of a range of clinically relevant biphasic pulse parameters on lethal EFT and adiabatic heating (AH). Cell death areas were assessed using fluorescent dyes and confocal microscopy, while lethal EFTs were quantified through comparison with electric field numerical simulations. Results and conclusion Our study confirmed a strong correlation between cell death in hiPSC-CMs and the number and duration of pulses in each train, with pulse repetition frequency exerting a comparatively weaker influence. Fitting of these results through machine learning algorithms were used to develop an open-source online calculator. By estimating lethal EFT and associated temperature increases for diverse pulse parameter combinations, this tool, once validated, has the potential to significantly reduce reliance on animal models during early-stage device de-risking and performance assessment. This tool also offers a promising avenue for advancing PFA technology for cardiac ablation medical devices to enhance patient outcomes.
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Affiliation(s)
- Maura Casciola
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States
| | | | | | | | - Ksenia Blinova
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States
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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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Kirstein B, Heeger CH, Vogler J, Eitel C, Feher M, Phan HL, Mushfiq I, Traub A, Hatahet S, Samara O, Subin B, Kuck KH, Tilz RR. Impact of pulsed field ablation on intraluminal esophageal temperature. J Cardiovasc Electrophysiol 2024; 35:78-85. [PMID: 37942843 DOI: 10.1111/jce.16096] [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: 05/07/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Atrio-esophageal fistula after esophageal thermal injury (ETI) is one of the most devastating complications of available energy sources for atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) uses electroporation as a new energy source for catheter ablation with promising periprocedural safety advantages over existing methods due to its unique myocardial tissue sensitivity. In preclinical animal studies, a dose-dependent esophageal temperature rise has been reported. In the TESO-PFA registry intraluminal esophageal temperature (TESO) changes in a clinical setting are evaluated. METHODS Consecutive symptomatic AF patients (62 years, 67% male, 61% paroxysmal AF, CHA2 DS2 Vasc Score 2) underwent first-time PFA and were prospectively enrolled into our registry. Eight pulse trains (2 kV/2.5 s, bipolar, biphasic, x4 basket/flower configuration each) were delivered to each pulmonary vein (PV). Two extra pulse trains per PV in flower configuration were added for wide antral circumferential ablation. Continuous intraluminal esophageal temperature (TESO) was monitored with a 12-pole temperature probe. RESULTS Median TESO change was statistically significant and increased by 0.8 ± 0.6°C, p < .001. A TESO increase ≥ 1°C was observed in 10/43 (23%) patients. The highest TESO measured was 40.3°C. The largest TESO difference (∆TESO) was 3.7°C. All patients remained asymptomatic considering possible ETI. No atrio-esophageal fistula was reported on follow-up. CONCLUSION A small but significant intraluminal esophageal temperature rise can be observed in most patients during PFA. TESO rise over 40°C is rare. The clinical implications of the observed findings need to be further evaluated.
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Affiliation(s)
- Bettina Kirstein
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Christian-H Heeger
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Huong-Lan Phan
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Ilias Mushfiq
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Anna Traub
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Sascha Hatahet
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Omar Samara
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Behnam Subin
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
| | - Roland R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany
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Aryana A, Hata C, de la Rama A, Nguyen K, Panescu D. A novel pulsed field ablation system using linear and spiral ablation catheters can create large and durable endocardial and epicardial ventricular lesions in vivo. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01714-6. [PMID: 38157151 DOI: 10.1007/s10840-023-01714-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We investigated the preclinical safety and efficacy of ventricular pulsed field ablation (PFA) using a family of novel, 6-/8-Fr, linear, and spiral PFA/mapping catheters (CRC EP, Inc). METHODS QRS-gated, bipolar PFA (>2.0 kV) was performed in 10 healthy swine. Altogether, 20 endocardial and epicardial right and left ventricular applications were delivered. The catheters were inserted through an 8.5-Fr steerable introducer. The intensity of skeletal muscle activation was quantified using an accelerometer. Lesions were assessed by pre- versus post-PFA electrogram analysis, pacing threshold, 3D voltage mapping, necropsy, and histology. The swine rete mirabile, liver and kidneys were examined for embolic events. RESULTS All applications were single-shot (56 ± 18 s) without catheter repositioning. Minimal microbubbling was observed without significant skeletal muscle stimulation (mean acceleration 0.05 m/s2) or ventricular tachyarrhythmias. There was significant reduction in post- versus pre-PFA electrogram amplitude (0.5 ± 0.2 mV versus 3.2 ± 0.9 mV, P < 0.001) with a marked increase in pacing threshold (>20 mA versus 7.5 ± 2.9 mA, P < 0.001). All lesions were large and durable up to 28 days, measuring 32 ± 5 mm (length), 27 ± 8 mm (width), and 8 ± 3 mm (depth) using the spiral catheters and 43 ± 1 mm (length), 7 ± 1 mm (width), and 8 ± 1 mm (depth) using the linear catheters. Despite higher waveform voltages and prolonged applications, no thermal effects were detected at necropsy/histology. Moreover, gross and microscopic examinations revealed no evidence of thromboembolism, vascular or collateral injury. CONCLUSIONS A novel, QRS-gated PFA system using linear and spiral PFA catheters is capable of creating large and durable ventricular lesions in vivo without significant microbubbling, ventricular arrhythmias or thromboembolism.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
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Pérez JJ, González-Suárez A. How intramyocardial fat can alter the electric field distribution during Pulsed Field Ablation (PFA): Qualitative findings from computer modeling. PLoS One 2023; 18:e0287614. [PMID: 37917621 PMCID: PMC10621855 DOI: 10.1371/journal.pone.0287614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 11/04/2023] Open
Abstract
Even though the preliminary experimental data suggests that cardiac Pulsed Field Ablation (PFA) could be superior to radiofrequency ablation (RFA) in terms of being able to ablate the viable myocardium separated from the catheter by collagen and fat, as yet there is no formal physical-based analysis that describes the process by which fat can affect the electric field distribution. Our objective was thus to determine the electrical impact of intramyocardial fat during PFA by means of computer modeling. Computer models were built considering a PFA 3.5-mm blunt-tip catheter in contact with a 7-mm ventricular wall (with and without a scar) and a 2-mm epicardial fat layer. High voltage was set to obtain delivered currents of 19, 22 and 25 A. An electric field value of 1000 V/cm was considered as the lethal threshold. We found that the presence of fibrotic tissue in the scar seems to have a similar impact on the electric field distribution and lesion size to that of healthy myocardium only. However, intramyocardial fat considerably alters the electrical field distribution and the resulting lesion shape. The electric field tends to peak in zones with fat, even away from the ablation electrode, so that 'cold points' (i.e. low electric fields) appear around the fat at the current entry and exit points, while 'hot points' (high electric fields) occur in the lateral areas of the fat zones. The results show that intramyocardial fat can alter the electric field distribution and lesion size during PFA due to its much lower electrical conductivity than that of myocardium and fibrotic tissue.
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Affiliation(s)
- Juan J. Pérez
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Translational Medical Device Lab, School of Engineering, University of Galway, Galway, Ireland
- Universidad Internacional de Valencia—VIU, Valencia, Spain
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Fang Z, Li X, Yan S, Si P, Ma F, Zhang W, Zhang B, Zhou T, Yang B. A novel polarity configuration for enhancing ablation depth of pulsed field ablation: Design, modeling, and in vivo validation. Med Phys 2023; 50:5364-5374. [PMID: 37493518 DOI: 10.1002/mp.16621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Pulsed field ablation (PFA) has been increasingly used to cut off the delivery of abnormal electrical signals in the treatment of cardiac arrhythmias. A successful cut off requires forming a layer of transmural damage on the heart wall, and this layer depends on the depth of ablation by PFA. PURPOSE This study aims to propose a novel polarity configuration of PFA to increase the ablation depth in the treatment of cardiac arrhythmias. METHOD A novel polarity configuration was designed for a multi-electrode system, where the number of electrodes is greater than two. The polarity configuration in such multi-electrode system is called the paired-electrode interlaced configuration (PIC). The existing configuration called the single-electrode interlaced configuration (SIC) was used to compare with the PIC. To both the SIC and PIC, a full-SIC or a full-PIC is called when all electrodes (anode, cathode) in a catheter is used otherwise partial-SIC or partial-PIC is called. By the comparison between the full-SIC and full-PIC, the benefit of the PIC was exhibited as opposed to the SIC, but an extra ablation step was added in the PIC in order to form a continuous ablation zone. The other comparative study was taken between a partial-PIC and a partial-SIC with the same number of ablation step. In this study, a rabbit model was built by infusing 0.4% saline solution (at 37°C) into the rabbit's abdominal cavity which surrounds the liver. This model was considered as a biometric environment of the heart, namely cardiac-mimetic model (CMM). RESULT The experimental results have shown that the full-PIC is superior to the full-SIC in the ablation depth, specifically in both the maximum (4.14 ± 0.55 mm vs. 3.35 ± 0.26 mm, p < 0.01) and the minimum (3.18 ± 0.29 mm vs. 2.76 ± 0.28 mm, p < 0.05), and in the ablation width, specifically only in the maximum (8.27 ± 0.76 mm vs. 7.09 ± 0.51 mm, p = 0.019) under an identical ablation time (i.e., 5 s). It is noted that the minimum ablation width did not show a significant difference between the full-PIC and full-SIC (specifically, 5.61 ± 0.86 mm vs. 4.67 ± 0.73 mm, p = 0.069). Considering the lethal electric field threshold (LEFT) to be 600 V/cm for liver tissues, the maximum and minimum ablation depth generated by the full-PIC was found larger than that by the full-SIC (3.90 vs. 3.52 mm, and 3.03 vs. 2.48 mm, respectively) in the simulation. Meanwhile, similar experiment results by comparing the partial-PIC and partial-SIC have been obtained, which shows a significant increase in both the maximum ablation depth (4.81 ± 0.87 mm vs. 3.30 ± 0.73 mm, p < 0.001) and the maximum ablation width (8.19 ± 0.85 mm vs. 6.47 ± 1.13 mm, p = 0.001). CONCLUSIONS (1) The electric field in the PIC is concentrated around the pair of electrodes, and the pattern of the field is a significant factor in the energy delivery along the direction of the depth. (2) The increase of the ablation depth can significantly expand the range of the tissue on the heart, where the PFA can apply, and can therefore readily form a layer of transmural damage on the heart wall at positions at which the wall is thicker.
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Affiliation(s)
- Zheng Fang
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Xiaorong Li
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Peng Si
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Fei Ma
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Wenjun Zhang
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Tuo Zhou
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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9
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Hartl S, Reinsch N, Füting A, Neven K. Pearls and Pitfalls of Pulsed Field Ablation. Korean Circ J 2023; 53:273-293. [PMID: 37161743 PMCID: PMC10172271 DOI: 10.4070/kcj.2023.0023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 05/11/2023] Open
Abstract
Pulsed field ablation (PFA) was recently rediscovered as an emerging treatment modality for the ablation of cardiac arrhythmias. Ultra-short high voltage pulses are leading to irreversible electroporation of cardiac cells subsequently resulting in cell death. Current literature of PFA for pulmonary vein isolation (PVI) consistently reported excellent acute and long-term efficacy along with a very low adverse event rate. The undeniable benefit of the novel ablation technique is that cardiac cells are more susceptible to electrical fields whereas surrounding structures such as the pulmonary veins, the phrenic nerve or the esophagus are not, or if at all, minimally affected, which results in a favorable safety profile that is expected to be superior to the current standard of care without compromising efficacy. Nevertheless, the exact mechanisms of electroporation are not yet entirely understood on a cellular basis and pulsed electrical field protocols of different manufactures are not comparable among one another and require their own validation for each indication. Importantly, randomized controlled trials and comparative data to current standard of care modalities, such as radiofrequency- or cryoballoon ablation, are still missing. This review focuses on the "pearls" and "pitfalls" of PFA, a technology that has the potential to become the future leading energy source for PVI and beyond.
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Affiliation(s)
- Stefan Hartl
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany.
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10
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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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11
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Casciola M, Feaster TK, Caiola MJ, Keck D, Blinova K. Human in vitro assay for irreversible electroporation cardiac ablation. Front Physiol 2023; 13:1064168. [PMID: 36699682 PMCID: PMC9869257 DOI: 10.3389/fphys.2022.1064168] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction: Pulsed electric field (PEF) cardiac ablation has been recently proposed as a technique to treat drug resistant atrial fibrillation by inducing cell death through irreversible electroporation (IRE). Improper PEF dosing can result in thermal damage or reversible electroporation. The lack of comprehensive and systematic studies to select PEF parameters for safe and effective IRE cardiac treatments hinders device development and regulatory decision-making. Human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) have been proposed as an alternative to animal models in the evaluation of cardiac electrophysiology safety. Methods: We developed a novel high-throughput in vitro assay to quantify the electric field threshold (EFT) for electroporation (acute effect) and cell death (long-term effect) in hiPSC-CMs. Monolayers of hiPSC-CMs were cultured in high-throughput format and exposed to clinically relevant biphasic PEF treatments. Electroporation and cell death areas were identified using fluorescent probes and confocal microscopy; electroporation and cell death EFTs were quantified by comparison of fluorescent images with electric field numerical simulations. Results: Study results confirmed that PEF induces electroporation and cell death in hiPSC-CMs, dependent on the number of pulses and the amplitude, duration, and repetition frequency. In addition, PEF-induced temperature increase, absorbed dose, and total treatment time for each PEF parameter combination are reported. Discussion: Upon verification of the translatability of the in vitro results presented here to in vivo models, this novel hiPSC-CM-based assay could be used as an alternative to animal or human studies and can assist in early nonclinical device development, as well as inform regulatory decision-making for cardiac ablation medical devices.
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12
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Zhao Z, Chen Y, Wu B, Qiu G, Hong L, Chen X, Zhang X. Pulsed-Field Ablation Using a Novel Ablation-Mapping Integrated System for Pulmonary Vein Isolation-A Preliminary Animal Study. J Cardiovasc Dev Dis 2022; 9:jcdd9120425. [PMID: 36547422 PMCID: PMC9781645 DOI: 10.3390/jcdd9120425] [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: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The purpose of this study is to evaluate the preliminary safety and effect of a pulsed electric field (PEF) ablation system. METHODS The pulmonary veins (PVs) and superior vena cava (SVC) were isolated with the pulsed field ablation (PFA) system, which included a PEF generator and an electrode. The effects of PFA were investigated in six porcines using a novel circular catheter with combined functions (mapping/ablation) designed to work with a cardiac mapping system. The PEF generator delivered a train of biphasic pulsed electric pulses with a high amplitude (800-2000 V) and short pulse duration. The voltage mapping, PVs and SVC potentials, ostial diameters, and phrenic nerve and esophagus viability data were collected 4 weeks later, after which the animals were subsequently euthanized for gross histopathology analysis. RESULTS PFA 100% isolated the PVs and SVC with four applications with a mean pulse number of 100-150 pulses, causing no muscle convulsion. PFA does not cause PV stenosis or phrenic nerve dysfunction. Histological analysis confirmed 100% transmurally without any venous stenoses or phrenic injuries. Pathology follow-up showed that PFA had selectively ablated cardiomyocytes but spared blood vessels, the esophagus, and phrenic nerves; after ablation, the myocardial tissue showed homogeneous fibrosis. CONCLUSION The PFA system is safe and feasible in the preliminary porcine model, which can effectively isolate PVs and SVCs. Transmural tissue damage can be achieved without phrenic palsy or stenosis.
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Affiliation(s)
- Zhihong Zhao
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
| | - Yonggang Chen
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
| | - Bin Wu
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
| | - Gaodong Qiu
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
| | - Liangjie Hong
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
| | - Xinhua Chen
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou 311121, China
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
- Correspondence: (X.C.); (X.Z.)
| | - Xingwei Zhang
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
- Correspondence: (X.C.); (X.Z.)
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13
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Gómez-Barea M, García-Sánchez T, Ivorra A. A computational comparison of radiofrequency and pulsed field ablation in terms of lesion morphology in the cardiac chamber. Sci Rep 2022; 12:16144. [PMID: 36167959 PMCID: PMC9515184 DOI: 10.1038/s41598-022-20212-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Pulsed Field Ablation (PFA) has been developed over the last years as a novel electrical ablation technique for treating cardiac arrhythmias. It is based on irreversible electroporation which is a non-thermal phenomenon innocuous to the extracellular matrix and, because of that, PFA is considered to be safer than the reference technique, Radiofrequency Ablation (RFA). However, possible differences in lesion morphology between both techniques have been poorly studied. Simulations including electric, thermal and fluid physics were performed in a simplified model of the cardiac chamber which, in essence, consisted of a slab of myocardium with blood in motion on the top. Monopolar and bipolar catheter configurations were studied. Different blood velocities and catheter orientations were assayed. RFA was simulated assuming a conventional temperature-controlled approach. The PFA treatment was assumed to consist in a sequence of 20 biphasic bursts (100 µs duration). Simulations indicate that, for equivalent lesion depths, PFA lesions are wider, larger and more symmetrical than RFA lesions for both catheter configurations. RFA lesions display a great dependence on blood velocity while PFA lesions dependence is negligible on it. For the monopolar configuration, catheter angle with respect to the cardiac surface impacted both ablation techniques but in opposite sense. The orientation of the catheter with respect to blood flow direction only affected RFA lesions. In this study, substantial morphological differences between RFA and PFA lesions were predicted numerically. Negligible dependence of PFA on blood flow velocity and direction is a potential important advantage of this technique over RFA.
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Affiliation(s)
- Mario Gómez-Barea
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain.
| | - Tomás García-Sánchez
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
| | - Antoni Ivorra
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018, Barcelona, Spain
- Serra Húnter Fellow Programme, Universitat Pompeu Fabra, 08018, Barcelona, Spain
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14
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Pansera F, Bordignon S, Bologna F, Tohoku S, Chen S, Urbanek L, Schmidt B, Chun KRJ. Catheter ablation induced phrenic nerve palsy by pulsed field ablation—completely impossible? A case series. Eur Heart J Case Rep 2022; 6:ytac361. [PMID: 36128440 PMCID: PMC9477201 DOI: 10.1093/ehjcr/ytac361] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
Background Pulsed field ablation (PFA) is a new feasible and safe method for the ablative treatment of cardiac arrhythmias, such as atrial fibrillation (AF). Through the use of electric fields, it causes pore-like openings in the cell’s wall, leading to cell death. The most appealing characteristic of this new technique is its selectivity for cardiomyocytes and consequently its low risk of collateral damage to extracardiac tissues. We present three cases of a PFA-induced transient phrenic nerve (PN) injury documented during pulmonary vein isolation (PVI). Case summaries Three patients aged 55–81 years underwent PFA for symptomatic AF. Cases 1 and 3 were affected by paroxysmal AF without evidence of structural heart disease. Case 2 had persistent AF and ischaemic cardiomyopathy with preserved ejection fraction. We observed a transient right hemidiaphragm palsy during the delivery of impulses in the right superior pulmonary vein (Cases 1 and 2) and in the right inferior pulmonary vein (Case 3). The palsy lasted <1 min and was followed by spontaneous full recovery in all cases. Discussion Transient PN dysfunction can be observed following PFA in AF ablation. According to our initial experience, a full recovery of the PN function can be expected within seconds. We hypothesize a hyperpolarization of neuronal cells or a depletion of acetylcholine in the motoric endplate to explain this event. Further studies are required to understand the exact pathophysiological mechanism.
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Affiliation(s)
- Francesco Pansera
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Stefano Bordignon
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Fabrizio Bologna
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Shota Tohoku
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Shaojie Chen
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Lukas Urbanek
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Boris Schmidt
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
| | - Kyoung-Ryul Julian Chun
- Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien , Wilhelm-Epstein-Straße 4, 60431 Frankfurt am Main , Germany
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15
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van Zyl M, Ladas TP, Tri JA, Yasin OZ, Ladejobi AO, Tan NY, Christopoulos G, Schneider N, Danitz DJ, Uecker D, DeSimone CV, Killu AM, Maor E, Asirvatham SJ. Bipolar Electroporation Across the Interventricular Septum. JACC Clin Electrophysiol 2022; 8:1106-1118. [DOI: 10.1016/j.jacep.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
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16
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Grimaldi M, Di Monaco A, Gomez T, Berman D, Datta K, Sharma T, Govari A, Altman A, Di Biase L. Time Course of Irreversible Electroporation Lesion Development Through Short- and Long-Term Follow-Up in Pulsed-Field Ablation-Treated Hearts. Circ Arrhythm Electrophysiol 2022; 15:e010661. [PMID: 35763432 DOI: 10.1161/circep.121.010661] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a tissue-selective, nonthermal cardiac ablation modality. A novel PFA ablation system consisted of a multichannel irreversible electroporation generator system and a multielectrode circular irreversible electroporation catheter has been developed for catheter ablation. To understand the progression and immediate impacts of PFA, this study evaluated the subchronic (7±3 day) and chronic (30±3 day) safety and performance of the novel PFA system when simulating pulmonary vein and superior vena cava isolation in a porcine beating heart model. METHODS Ten swine models were divided into subchronic (n=6) and chronic cohorts (n=4). Lesions were performed within the right and left atrium to conduct right pulmonary veins and superior vena cava isolations, in addition to creating stacked lesions in the left atrium roof and right atrium posterior wall. RESULTS Acute pulmonary vein and superior vena cava isolation were achieved in 10 out of 10 swine and demonstrated 100% lesion durability in both cohorts, including sustained elimination of electrical activity at the left atrium roof and right atrium posterior wall. Histology demonstrated that all the cardiac sites ablated showed discrete zones of loss of myocardial fibers or smooth muscle cells with preservation of the tissue architecture with resultant fibrocellular replacement, neovascularization, and neocollagen deposition. Mineralization findings were present in association with residual necrotic muscle fibers. Only in 7 days group, areas of mineralization were frequently associated with inflammation. There were no treatment-related changes in other tissues, including complete sparing of the phrenic nerve. CONCLUSIONS Pulsed-field ablation for pulmonary vein and superior vena cava isolation with the novel PFA system was feasible, safe with myocardial-specific ablative effect. Durable lesions were observed at the target areas. with inflammation phenomena mainly documented at 7 days.
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Affiliation(s)
- Massimo Grimaldi
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy (M.G., A.D.M.)
| | - Antonio Di Monaco
- Ospedale Generale Regionale "F. Miulli," Dipartimento di Cardiologia, Acquaviva delle Fonti, Bari, Italy (M.G., A.D.M.)
| | - Tara Gomez
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Dror Berman
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Keshava Datta
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Tushar Sharma
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Assaf Govari
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Andres Altman
- Biosense Webster, Inc, Irvine, CA (T.G., D.B., K.D., T.S., A.G., A.A.)
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX (L.D.B.).,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.D.B.)
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17
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Compact High-Voltage AC Generator with Pulse Transformer for High-Frequency Irreversible Electroporation (H-FIRE). ELECTRONICS 2021. [DOI: 10.3390/electronics10232898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper is focused on a design of a high-voltage (HV) generator, which is proposed for a high-frequency irreversible electroporation (H-FIRE). The generator produces bursts of bipolar symmetrical pulses. Most HV sources used for cell electroporation are based on a controlled discharge of a capacitor into a resistive load. This solution is very simple, but it is associated with a certain risk of an uncontrolled discharge of the capacitor. We present a different type of the generator, where a DC-AC inverter with pulse transformer is used and where the mentioned risk is eliminated. Our generator is able to deliver bursts with variable length from 50 to 150 μs and a gap between bursts can be set from 0.5 to 1.5 s. Pulse frequency can be varied from 65 to 470 kHz and the output voltage is controlled in two ranges from 0 to 1.3 kV or from 0 to 2.5 kV. Results are presented with resistive load and with tissue impedance load.
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18
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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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