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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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2
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Pierucci N, Mariani MV, Laviola D, Silvetti G, Cipollone P, Vernile A, Trivigno S, La Fazia VM, Piro A, Miraldi F, Vizza CD, Lavalle C. Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications. J Clin Med 2024; 13:2980. [PMID: 38792520 PMCID: PMC11121906 DOI: 10.3390/jcm13102980] [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: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA's ability to achieve pulmonary vein isolation-a cornerstone of AF treatment-rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA's effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols.
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Affiliation(s)
- Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Pietro Cipollone
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Antonio Vernile
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Sara Trivigno
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | | | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Fabio Miraldi
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences “Sapienza”, University of Rome, 00161 Rome, Italy; (N.P.); (M.V.M.); (D.L.); (G.S.); (P.C.); (A.V.); (S.T.); (A.P.); (F.M.); (C.D.V.)
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3
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Jiang S, Qian F, Ji S, Li L, Liu Q, Zhou S, Xiao Y. Pulsed Field Ablation for Atrial Fibrillation: Mechanisms, Advantages, and Limitations. Rev Cardiovasc Med 2024; 25:138. [PMID: 39076550 PMCID: PMC11264014 DOI: 10.31083/j.rcm2504138] [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: 10/11/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 07/31/2024] Open
Abstract
Pulsed field ablation with irreversible electroporation for the treatment of atrial fibrillation involves tissue-specific and non-thermal energy-induced cell necrosis, which helps avoid complications, such as pulmonary vein stenosis, atrial collateral tissue damage, and extensive atrial structural damage, often encountered with traditional thermal ablation. In existing clinical trials, pulsed field ablation has shown excellent effects on pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Pulsed field ablation is easy, simple, and quick and can reduce iatrogenic injury. Therefore, the application of pulsed field ablation technology in the treatment of atrial fibrillation has a promising future. Notably, the adjustment of parameters in pulsed field ablation with different ablation catheter systems can strongly affect the area and depth of the necrotic myocardium, which greatly affects the likelihood of atrial fibrillation recurrence and incidence of adverse complications after ablation. In this paper, we review the mechanisms, advantages, and limitations of pulsed field ablation based on the results of a series of previous studies and provide ideas and directions for future research.
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Affiliation(s)
- Shali Jiang
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, 410013 Changsha, Hunan, China
| | - Frank Qian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shuting Ji
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, 410013 Changsha, Hunan, China
| | - Luohong Li
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
- Xiangya School of Medicine, Central South University, 410013 Changsha, Hunan, China
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China
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Scuderi M, Dermol-Cerne J, Scancar J, Markovic S, Rems L, Miklavcic D. The equivalence of different types of electric pulses for electrochemotherapy with cisplatin - an in vitro study. Radiol Oncol 2024; 58:51-66. [PMID: 38378034 PMCID: PMC10878774 DOI: 10.2478/raon-2024-0005] [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: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Electrochemotherapy (ECT) is a treatment involving the administration of chemotherapeutics drugs followed by the application of 8 square monopolar pulses of 100 μs duration at a repetition frequency of 1 Hz or 5000 Hz. However, there is increasing interest in using alternative types of pulses for ECT. The use of high-frequency short bipolar pulses has been shown to mitigate pain and muscle contractions. Conversely, the use of millisecond pulses is interesting when combining ECT with gene electrotransfer for the uptake of DNA-encoding proteins that stimulate the immune response with the aim of converting ECT from a local to systemic treatment. Therefore, the aim of this study was to investigate how alternative types of pulses affect the efficiency of the ECT. MATERIALS AND METHODS We performed in vitro experiments, exposing Chinese hamster ovary (CHO) cells to conventional ECT pulses, high-frequency bipolar pulses, and millisecond pulses in the presence of different concentrations of cisplatin. We determined cisplatin uptake by inductively coupled plasma mass spectrometry and cisplatin cytotoxicity by the clonogenic assay. RESULTS We observed that the three tested types of pulses potentiate the uptake and cytotoxicity of cisplatin in an equivalent manner, provided that the electric field is properly adjusted for each pulse type. Furthermore, we quantified that the number of cisplatin molecules, resulting in the eradication of most cells, was 2-7 × 107 per cell. CONCLUSIONS High-frequency bipolar pulses and millisecond pulses can potentially be used in ECT to reduce pain and muscle contraction and increase the effect of the immune response in combination with gene electrotransfer, respectively.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janja Dermol-Cerne
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Scancar
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Stefan Markovic
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Damijan Miklavcic
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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5
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Chen B, Lv C, Cui Y, Lu C, Cai H, Xue Z, Xu X, Su S. A pilot clinical assessment of biphasic asymmetric pulsed field ablation catheter for pulmonary vein isolation. Front Cardiovasc Med 2024; 11:1266195. [PMID: 38385135 PMCID: PMC10879394 DOI: 10.3389/fcvm.2024.1266195] [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: 09/08/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Pulsed field ablation (PFA) is a new treatment for atrial fibrillation (AF), and its selective ablation characteristics give it a significant advantage in treatment. In previous cellular and animal experiments, we have demonstrated that biphasic asymmetric pulses can be used to ablate myocardial tissue. However, small-scale clinical trials are needed to test whether this approach is safe and feasible before extensive clinical trials can be performed. Therefore, the purpose of this experiment is to determine the safety and feasibility of biphasic asymmetric pulses in patients with AF and is to lay the foundation for a larger clinical trial. Ablation was performed in 10 patients with AF using biphasic asymmetric pulses. Voltage mapping was performed before and after PFA operation to help us detect the change in the electrical voltage of the pulmonary veins (PV). 3-Dimensional mapping system showed continuous low potential in the ablation site, and pulmonary vein isolation (PVI) was achieved in all four PV of the patients. There were no recurrences, PV stenosis, or other serious adverse events during the 12 months follow-up. The results suggest that PFA using biphasic asymmetric waveforms for patients with AF is safe, durable, and effective and that a larger clinical trial could begin. Clinical Trial Registration https://www.chictr.org.cn/, identifier, ChiCTR2100051894.
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Affiliation(s)
- Bingwei Chen
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Chang Lv
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Yingjian Cui
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Heng Cai
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhixiao Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Xinyu Xu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Siying Su
- Department of Research and Development, Tianjin Intelligent Health Medical Co., Ltd., Tianjin, China
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Chinyere IR, Mori S, Hutchinson MD. Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation. VESSEL PLUS 2024; 8:7. [PMID: 38646143 PMCID: PMC11027649 DOI: 10.20517/2574-1209.2023.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA's effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.
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Affiliation(s)
- Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Mathew D. Hutchinson
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner Health, Tucson, AZ 85719, USA
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7
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Di Biase L, Marazzato J, Zou F, Lin A, Grupposo V, Chowdhuri N, Maffre J, Farshchi-Heydari S, Sharma T, Beeckler C, Govari A, Bhardwaj R, Mohanty S, Natale A, Nakagawa H, Zhang X. Point-by-Point Pulsed Field Ablation Using a Multimodality Generator and a Contact Force-Sensing Ablation Catheter: Comparison With Radiofrequency Ablation in a Remapped Chronic Swine Heart. Circ Arrhythm Electrophysiol 2023; 16:663-671. [PMID: 37994554 PMCID: PMC10734778 DOI: 10.1161/circep.123.012344] [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: 08/15/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) has emerged as an alternative to radiofrequency ablation. However, data on focal point-by-point PFA are scarce. The aim of this study was to compare lesion durability and collateral damage between focally delivered unipolar/biphasic PFA versus radiofrequency in swine. METHODS Eighteen swine were randomized to low-dose PFA, high-dose PFA, and radiofrequency using a multimodality generator. Radiofrequency delivered by market-available generator served as control group. A contact force-sensing catheter was used to focally deliver PFA/radiofrequency at the pulmonary veins and other predefined sites in the atria. Animals were remapped postprocedurally and 28 days postablation to test lesion durability followed by gross necroscopy and histology. RESULTS All targeted sites were successfully ablated (contact force value, 13.9±4.1 g). Follow-up remapping showed persistent pulmonary vein isolation in all animals (100%) with lesion durability at nonpulmonary vein sites proven in most (98%). Regardless of the energy source used, the lesion size was similar across the study groups. Transmurality was achieved in 95% of targeted sites and 100% at pulmonary veins. On histology, PFA animals showed more mature scar formation than their radiofrequency counterpart without myocardial necrosis or inflammation. Finally, no sign of collateral damage was observed in any of the groups. CONCLUSIONS In a randomized preclinical study, focally delivered unipolar/biphasic PFA guided by contact force values was associated with durable lesions on chronic remapping and with mature scar formation on histology without signs of collateral injury on necroscopy. Further studies are needed to investigate the long-term feasibility of this new approach to atrial fibrillation treatment.
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Affiliation(s)
- Luigi Di Biase
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
| | - Jacopo Marazzato
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
| | - Fengwei Zou
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
| | - Aung Lin
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
| | - Vito Grupposo
- Biosense Webster, Irvine, CA/Yokne’am, Israel (V.G., J.M., S.F.-H., T.S., C.B., A.G.)
| | - Nilarun Chowdhuri
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
| | - Jennifer Maffre
- Biosense Webster, Irvine, CA/Yokne’am, Israel (V.G., J.M., S.F.-H., T.S., C.B., A.G.)
| | | | - Tushar Sharma
- Biosense Webster, Irvine, CA/Yokne’am, Israel (V.G., J.M., S.F.-H., T.S., C.B., A.G.)
| | - Christopher Beeckler
- Biosense Webster, Irvine, CA/Yokne’am, Israel (V.G., J.M., S.F.-H., T.S., C.B., A.G.)
| | - Assaf Govari
- Biosense Webster, Irvine, CA/Yokne’am, Israel (V.G., J.M., S.F.-H., T.S., C.B., A.G.)
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., A.N.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., A.N.)
| | - Hiroshi Nakagawa
- Section of Cardiac Electrophysiology & Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, OH (H.N.)
| | - Xiaodong Zhang
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Health System, NY (L.D.B., J.M., F.Z., A.L., N.C., X.Z.)
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Teng P, Wu Y, Chen R, Hong L, Wu B, Liu L, Ma L, Zhao H, Wu S. Pulsed field ablation as a precise approach for cardiac arrhythmia treatment via cardiac microenvironment remodeling. Bioelectrochemistry 2023; 154:108502. [PMID: 37453203 DOI: 10.1016/j.bioelechem.2023.108502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PFA uses short-duration, high-voltage electrical pulses to induce transient or irreversible electroporation on cell membranes, causing cell death. Selective inhibition of chaotic electrical signals in morbid cardiomyocytes significantly aids the treatment of atrial fibrillation, ventricular tachycardia, and other heart arrhythmias. Recent preclinical and clinical studies have only investigated physical changes, such as lesion size and myocardial scar. Compared to radiofrequency ablation and cryoballoon ablation, PFA causes less postoperative myocardial cell fibrosis and inflammatory reaction and does not result in myocardial necrosis or tissue scar formation. However, the regulatory mechanism of cellular stress following PFA treatment remains unknown. This study aimed to analyze the transcriptome of the mouse ventricle after PFA treatment. The animals were subjected to a 225-V electric pulse with a 1.5-mm gap between the positive and negative electrodes. Hearts were harvested at 3, 6, 12, 24 h, and 2, 5 days for myocardial zymogram testing. PFA-treated ventricular regions were selected for single-nucleus sequencing. We discovered that PFA remodeled the cardiac microenvironment as a whole. Further, we discussed the possible stress response and wound-healing mechanism in non-targeted cells. In conclusion, PFA allowed effective and selective ventricular myocardium ablation with controllable inflammation.
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Affiliation(s)
- Peng Teng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China
| | - Yuefeng Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; The Lab of Biomed-X, Zhejiang University-University of Edinburgh Institute (ZJU-UoE), School of Medicine, Zhejiang University, Haining, 310000, China
| | - Ruoshi Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Liangjie Hong
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China
| | - Bin Wu
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China
| | - Lingshan Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Haige Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
| | - Shengjun Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China.
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9
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Iyengar SK, Iyengar S, Srivathsan K. The promise of pulsed field ablation and the challenges ahead. Front Cardiovasc Med 2023; 10:1235317. [PMID: 37937293 PMCID: PMC10627215 DOI: 10.3389/fcvm.2023.1235317] [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: 06/06/2023] [Accepted: 10/05/2023] [Indexed: 11/09/2023] Open
Abstract
For many years, guidelines have suggested thermal ablation for the treatment of atrial fibrillation. Thermal ablation involves the destruction of tissue, leading to multiple complications. This ablation technique has been tried and tested, however, newer techniques are being investigated in order to avoid these complications. Pulsed field ablation, a nonthermal method of tissue ablation, is being explored as a more safe and efficient way to treat atrial fibrillation. This mini review aims to highlight the mechanisms of pulsed field ablation, its history and evolution, previous studies showing its efficacy, its major challenges and pitfalls, and future advancements to overcome these challenges. This method of ablation could potentially revolutionize the treatment of atrial fibrillation and prevent recurrences, thereby making it easier for the physicians and patients involved.
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Affiliation(s)
| | | | - Komandoor Srivathsan
- The Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, AZ, United States
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10
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Dunne E, Baena-Montes JM, Donaghey K, Clarke C, Kraśny MJ, Amin B, O’Halloran T, Quinlan LR, Elahi A, O’Halloran M. A Predictive and an Optimization Mathematical Model for Device Design in Cardiac Pulsed Field Ablation Using Design of Experiments. J Cardiovasc Dev Dis 2023; 10:423. [PMID: 37887870 PMCID: PMC10607717 DOI: 10.3390/jcdd10100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Cardiac catheter ablation (CCA) is a common method used to correct cardiac arrhythmia. Pulsed Field Ablation (PFA) is a recently-adapted CCA technology whose ablation is dependent on electrode and waveform parameters (factors). In this work, the use of the Design of Experiments (DoE) methodology is investigated for the design and optimization of a PFA device. The effects of the four factors (input voltage, electrode spacing, electrode width, and on-time) and their interactions are analyzed. An empirical model is formed to predict and optimize the ablation size responses. Based on the ranges tested, the significant factors were the input voltage, the electrode spacing, and the on time, which is in line with the literature. Two-factor interactions were found to be significant and need to be considered in the model. The resulting empirical model was found to predict ablation sizes with less than 2.1% error in the measured area and was used for optimization. The findings and the strong predictive model developed highlight that the DoE approach can be used to help determine PFA device design, to optimize for certain ablation zone sizes, and to help inform device design to tackle specific cardiac arrhythmias.
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Affiliation(s)
- Eoghan Dunne
- Translational Medical Device Lab (TMD Lab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Jara M. Baena-Montes
- Physiology and Cellular Physiology Research Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, University of Galway, H91 TK33 Galway, Ireland
| | - Kevin Donaghey
- AuriGen Medical, GMIT Innovation Hubs, H91 DCH9 Galway, Ireland
| | - Cormac Clarke
- AuriGen Medical, GMIT Innovation Hubs, H91 DCH9 Galway, Ireland
| | - Marcin J. Kraśny
- Translational Medical Device Lab (TMD Lab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Smart Sensors Lab, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Bilal Amin
- Translational Medical Device Lab (TMD Lab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Smart Sensors Lab, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Electrical & Electronic Engineering, College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
| | - Tony O’Halloran
- AuriGen Medical, GMIT Innovation Hubs, H91 DCH9 Galway, Ireland
| | - Leo R. Quinlan
- Physiology and Cellular Physiology Research Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, University of Galway, H91 TK33 Galway, Ireland
| | - Adnan Elahi
- Translational Medical Device Lab (TMD Lab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Smart Sensors Lab, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Electrical & Electronic Engineering, College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
| | - Martin O’Halloran
- Translational Medical Device Lab (TMD Lab), Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
- Electrical & Electronic Engineering, College of Science and Engineering, University of Galway, H91 TK33 Galway, Ireland
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Scuderi M, Dermol-Černe J, Batista Napotnik T, Chaigne S, Bernus O, Benoist D, Sigg DC, Rems L, Miklavčič D. Characterization of Experimentally Observed Complex Interplay between Pulse Duration, Electrical Field Strength, and Cell Orientation on Electroporation Outcome Using a Time-Dependent Nonlinear Numerical Model. Biomolecules 2023; 13:727. [PMID: 37238597 PMCID: PMC10216437 DOI: 10.3390/biom13050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Electroporation is a biophysical phenomenon involving an increase in cell membrane permeability to molecules after a high-pulsed electric field is applied to the tissue. Currently, electroporation is being developed for non-thermal ablation of cardiac tissue to treat arrhythmias. Cardiomyocytes have been shown to be more affected by electroporation when oriented with their long axis parallel to the applied electric field. However, recent studies demonstrate that the preferentially affected orientation depends on the pulse parameters. To gain better insight into the influence of cell orientation on electroporation with different pulse parameters, we developed a time-dependent nonlinear numerical model where we calculated the induced transmembrane voltage and pores creation in the membrane due to electroporation. The numerical results show that the onset of electroporation is observed at lower electric field strengths for cells oriented parallel to the electric field for pulse durations ≥10 µs, and cells oriented perpendicular for pulse durations ~100 ns. For pulses of ~1 µs duration, electroporation is not very sensitive to cell orientation. Interestingly, as the electric field strength increases beyond the onset of electroporation, perpendicular cells become more affected irrespective of pulse duration. The results obtained using the developed time-dependent nonlinear model are corroborated by in vitro experimental measurements. Our study will contribute to the process of further development and optimization of pulsed-field ablation and gene therapy in cardiac treatments.
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Affiliation(s)
- Maria Scuderi
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Janja Dermol-Černe
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Tina Batista Napotnik
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Sebastien Chaigne
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Olivier Bernus
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - David Benoist
- INSERM, CRCTB, U 1045, IHU Liryc, University of Bordeaux, F-33000 Bordeaux, France
| | - Daniel C. Sigg
- Medtronic, Cardiac Ablation Solutions, Minneapolis, MN 55105, USA
| | - Lea Rems
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Damijan Miklavčič
- Faculty of Electrical Engineering, University of Ljubljana, SI-1000 Ljubljana, Slovenia
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12
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Fan S, Jia F, Cui Y, Wu D, He L, Zhang F, Xue Z, Xu X, Lu F, Ma W, Su S, Chen Y, Liu Z. Study on the process of cardiomyocyte apoptosis after pulsed field ablation. Front Cardiovasc Med 2023; 10:1112131. [PMID: 37089889 PMCID: PMC10113644 DOI: 10.3389/fcvm.2023.1112131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundThe development of pulsed field ablation (PFA) as a new technique for pulmonary vein isolation (PVI) has been advancing rapidly in recent years. My team's previous work has shown the safety and long-term efficacy of bipolar asymmetric pulses in animal experiments. However, in ongoing clinical trials, we have observed that atrial fibrillation (AF) recurs in some patients after surgery, but the rhythm returns to normal without surgical intervention after seven days, and there is no recurrence in the follow-up.Based on this observation, we have proposed the hypothesis that myocardial cell apoptosis may play a role in AF recurrence after PFA. Our team has designed animal experiments to verify this hypothesis and further investigate the process of PFA-induced cardiomyocyte apoptosis.MethodsPulse field ablation was performed on 15 dogs and the animals were dissected at various time points after the operation (immediately, 3 days, 7 days, 30 days, and 150 days). To obtain ablation voltage maps, electroanatomic mapping was performed before and after ablation and before dissection. The ablation area was also subjected to HE and TUNEL staining to analyze apoptosis and pathological results.ResultsThe edge area of the ablation in the pulmonary vein (PV) demonstrated continuous dynamic changes from 0 to 2 h after the operation and a slight expansion of the ablation range was observed in the long-term follow-up. Myocardial intima hyperplasia was observed from 0 to 7 days. Local apoptosis was detected from 0 to 2 h and massive, concentrated apoptosis was observed at 3 days. No recurrence of apoptosis was seen at 7 days, 30 days, and 150 days.ConclusionsThe results of this study showed that after pulse field ablation (PFA), the central ablation area of the canine heart experienced immediate cardiomyocyte death. Meanwhile, cardiomyocytes in the edge ablation area underwent apoptosis, which began from 0 to 2 h post-operation and ended between 3 and 7 days. This process occurred simultaneously with intimal thickening.In the long-term follow-up group, there was no recovery of isolation and no recurrence of cardiomyocyte apoptosis, and no change was observed in the endomyocardial intima.
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Affiliation(s)
- Shaobo Fan
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Fenglin Jia
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Yingjian Cui
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Dongyan Wu
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Le He
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Fan Zhang
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
| | - Zhixiao Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
- Correspondence: Zhixiao Xue Xinyu Xu Fengmin Lu Wei Ma
| | - Xinyu Xu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
- Correspondence: Zhixiao Xue Xinyu Xu Fengmin Lu Wei Ma
| | - Fengmin Lu
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
- Correspondence: Zhixiao Xue Xinyu Xu Fengmin Lu Wei Ma
| | - Wei Ma
- Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China
- Correspondence: Zhixiao Xue Xinyu Xu Fengmin Lu Wei Ma
| | - Siying Su
- Department of Research and Development, Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China
| | - Yanpeng Chen
- Department of Research and Development, Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China
| | - Zhenxu Liu
- Department of Research and Development, Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China
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Zhao Z, Chen Y, Wu B, Qiu G, Hong L, Chen X, Zhang X. Study of necrotic apoptosis by pulsed electric field ablation in rabbit left ventricular myocardium. Front Cardiovasc Med 2022; 9:1012020. [PMID: 36225956 PMCID: PMC9548611 DOI: 10.3389/fcvm.2022.1012020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWe investigate the characteristics of histological damage to myocardial cells in the ablation region and surrounding areas of the left ventricular epicardium in rabbits using our self-developed cardiac pulsed electric field (PEF) ablation instrument and ablation catheter.MethodsForty eight New Zealand rabbits underwent ablation on the left ventricular myocardium after open-heart exposure with a cardiac arrhythmia PEF ablation device and ablation catheter developed by the Medical Translation Laboratory of Pulsed Electric Field Technology in Zhejiang Province. The ablation parameters were set as biphasic electrical pulses; voltage, ±800 V; pulse width, 10 μs; interphase delay, 500 us. Six rabbits were included in the sham group and 42 other rabbits were randomly divided into immediately, 6-h, 1-, 3-day, 1-, 2-, and 4-week post-ablation groups, with six rabbits in each group. Creatine kinase- (CK)-MB isoenzyme (CK-MB), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were measured before and at different time points after PEF ablation to analyze their dynamic evolution. Masson staining of tissue block sections of left ventricular myocardial ablation and adjacent tissue heart specimens was performed, and the occurrence of TUNEL apoptosis in myocardium tissue was analyzed.ResultsAll rabbits completed the PEF ablation procedure and the follow-up process. After PEF ablation, the levels of cardiac enzymes, including CK-MB, CK, and AST, increased significantly, peaking 1–3 days after the procedure. In particular, those of CK and CK-MB increased by 15–20 times but returned to the preoperative level after 2 weeks. Based on general observation, it was found that the myocardium in the ablation area was swollen immediately after PEF ablation. Masson staining analysis revealed that cardiomyocytes were broken and infiltrated by erythrocytes after 6 h. After 1 day, the cells started to experience atrophy and necrosis; after 3 days, fibrotic replacement of the necrotic area became obvious. Then, by 4 weeks, the myocardial cells were completely replaced by hyperplasia. Apoptosis occurred significantly at 6 h and peaked at 24 h post-ablation, demonstrating a 37.7-fold increase; apoptotic cell counts decreased significantly at 3 days post-ablation, and no significant apoptotic cardiomyocytes were seen after 1 week.ConclusionAfter PEF ablation, cardiomyocytes showed apoptotic process and dyed, at least partially, through a secondary necrosis, the ablation boundary was clear, the ablation area was replaced by structurally intact fibroblasts, no island myocardium tissue were seen, and the ablation area vessels and nerves were not affected.
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Affiliation(s)
- Zhihong Zhao
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
| | - Yonggang Chen
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
| | - Bin Wu
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
| | - Gaodong Qiu
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
| | - Liangjie Hong
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
| | - Xinhua Chen
- Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, China
- Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
- *Correspondence: Xinhua Chen
| | - Xingwei Zhang
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
- Xingwei Zhang
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Di Monaco A, Vitulano N, Troisi F, Quadrini F, Romanazzi I, Calvi V, Grimaldi M. Pulsed Field Ablation to Treat Atrial Fibrillation: A Review of the Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9040094. [PMID: 35448070 PMCID: PMC9030965 DOI: 10.3390/jcdd9040094] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and catheter ablation, which can be used in symptomatic patients refractory to antiarrhythmic therapy. Pulmonary vein isolation (PVI) remains the cornerstone of any ablation procedure. A major limitation of current catheter ablation procedures is important to recognize because even when the PVI is performed in highly experienced centers, PVI reconnection was documented in about 20% of patients. Therefore, better technology is needed to improve ablation lesions. One of the novelties in recent years is pulsed filed ablation (PFA), a non-thermal energy that uses trains of high-voltage, very-short-duration pulses to kill the cells. The mechanism of action of this energy consists of creating pores in the myocardiocyte cell membrane in a highly selective and tissue-specific way; this leads to death of the target cells reducing the risk of damage to surrounding non-cardiac tissues. In particular during the animal studies, PVI and atrial lines were performed effectively without PV stenosis. Using PFA directly on coronary arteries, there was no luminal narrowing, there has been no evidence of incidental phrenic nerve injury, and finally, PFA has been shown not to injure esophageal tissue when directly applied to the esophagus or indirectly through ablation in the left atrium. The aim of this review is to report all published animal and clinical studies regarding this new technology to treat paroxysmal and persistent AF.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-33-9735-1594
| | - Nicola Vitulano
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Federica Troisi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Federico Quadrini
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
| | - Imma Romanazzi
- Department of Cardiology, Policlinico “G. Rodolico”—Azienda O.U. Policlinico “G. Rodolico”—San Marco, 95125 Catania, Italy; (I.R.); (V.C.)
| | - Valeria Calvi
- Department of Cardiology, Policlinico “G. Rodolico”—Azienda O.U. Policlinico “G. Rodolico”—San Marco, 95125 Catania, Italy; (I.R.); (V.C.)
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy; (N.V.); (F.T.); (F.Q.); (M.G.)
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Bi S, Jia F, Lv C, He Q, Xu X, Xue Z, Su S. Preclinical Study of Biphasic Asymmetric Pulsed Field Ablation. Front Cardiovasc Med 2022; 9:859480. [PMID: 35402543 PMCID: PMC8987372 DOI: 10.3389/fcvm.2022.859480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Pulsed field ablation (PFA) is a novel method of pulmonary venous isolation in atrial fibrillation ablation and is featured by tissue-selective ablation. Isolation is achieved via the application of high-voltage microsecond pulses that create irreversible perforations in cell membranes (i.e., electroporation). We proposed a new biphasic asymmetric pulse mode and verified the lesion persistence and safety of this mode for pulmonary vein ostia ablation in preclinical studies. We found that biphasic asymmetric pulses can effectively reduce muscle contractions and drop ablation threshold. In the electroanatomic mapping, the ablation site showed a continuous low potential area, and the atrium was not captured after 30 days of pacing. Pathological staining showed that cardiomyocytes in the ablation area were replaced by fibroblasts and there was no damage outside the ablation zone. Our results show that pulmonary venous isolation using the biphasic asymmetric discharge mode is safe, durable, effective, and causes no damage to other tissues.
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Affiliation(s)
- Shengyu Bi
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Fenglin Jia
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Chang Lv
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Qiang He
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Xinyu Xu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
- *Correspondence: Xinyu Xu
| | - Zhixiao Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
- Zhixiao Xue
| | - Siying Su
- Tianjin Intelligent Health Medical Co., Ltd., Tianjin, China
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