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Tang JE, Guirguis F, Stein EJ, Essandoh MK, Iyer MH. Pulse Field Ablation: The Electric Future of Cardiac Ablation. J Cardiothorac Vasc Anesth 2024; 38:2139-2142. [PMID: 39004568 DOI: 10.1053/j.jvca.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Jonathan E Tang
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Fady Guirguis
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Erica J Stein
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH
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Gunawardene M, Arentz T. [Pulsed-field ablation-is it the only energy source for ablation in the future? : Pro/Contra]. Herzschrittmacherther Elektrophysiol 2024:10.1007/s00399-024-01035-9. [PMID: 39225800 DOI: 10.1007/s00399-024-01035-9] [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: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
Pulsed field ablation (PFA) is a nonthermal energy source used for cardiac ablation procedures. Cell death during PFA occurs via electroporation: ultrarapid (micro- to nanosecond) electrical pulses are applied to destabilize cell membranes causing irreversible pores. PFA leads to preferential ablation of myocardiocytes, sparing adjacent tissue like the esophagus or phrenic nerve. Preliminary clinical studies show high efficacy and a good safety profile in atrial fibrillation patients undergoing pulmonary vein isolation. The question remains, however, whether this new technology will replace well-known and established thermal energy sources like radiofrequency current or cryoablation within the next 5 years.
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Affiliation(s)
- Melanie Gunawardene
- Kardiologie und Internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - Thomas Arentz
- Sektion Rhythmologie, Klinik für Kardiologie und Angiologie II, Universitätsklinikum Freiburg, Freiburg, Deutschland.
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Peichl P, Bulava A, Wichterle D, Schlosser F, Stojadinović P, Borišincová E, Štiavnický P, Hašková J, Kautzner J. Efficacy and safety of focal pulsed-field ablation for ventricular arrhythmias: two-centre experience. Europace 2024; 26:euae192. [PMID: 38988256 PMCID: PMC11264298 DOI: 10.1093/europace/euae192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/06/2024] [Indexed: 07/12/2024] Open
Abstract
AIMS A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF. METHODS AND RESULTS The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA. CONCLUSION Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
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Affiliation(s)
- Petr Peichl
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Alan Bulava
- České Budějovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice, České Budějovice, Czechia
| | - Dan Wichterle
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Filip Schlosser
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Predrag Stojadinović
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Eva Borišincová
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Peter Štiavnický
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Jana Hašková
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
| | - Josef Kautzner
- Department of Cardiology, IKEM, Vídeňská 1958/9, Praha 4, Prague 140 21, Czechia
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Falzone PV, Vazquez-Calvo S, Roca-Luque I. Catheter Ablation of Ventricular Tachycardia in Ischemic Heart Disease: What Is Known and New Perspectives. Curr Heart Fail Rep 2024; 21:174-185. [PMID: 38536648 DOI: 10.1007/s11897-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to evaluate current evidence regarding ventricular tachycardia ablation in patients with ischemic heart disease and explore novel approaches currently developing to improve procedural and long-term outcomes. RECENT FINDINGS Recently published trials (PARTITA, PAUSE-SCD, and SURVIVE-VT) have demonstrated the prognostic benefit of prophylactic ventricular tachycardia ablation compared to current clinical practice. Advanced cardiac imaging provides a valuable pre-procedural evaluation of the arrhythmogenic substrate, identifying ablation targets non-invasively. Advanced cardiac mapping techniques allow to better characterize arrhythmogenic substrate during ablation procedure. Emerging technologies like pulsed field ablation and ultra-low temperature cryoablation show promise in ventricular tachycardia ablation. Advancements in mapping techniques, ablation technologies, and pre-procedural cardiac imaging offer promise for improving ventricular tachycardia ablation outcomes in ischemic heart disease.
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Affiliation(s)
- Pasquale Valerio Falzone
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Vazquez-Calvo
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Ngan HT, Tse HF. Expanding indications for pulsed-field ablation beyond the treatment of cardiac arrhythmias? Heart Rhythm 2024; 21:268-269. [PMID: 38065420 DOI: 10.1016/j.hrthm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Ho-Ting Ngan
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China; Cardiac and Vascular Center, Hong Kong University Shenzhen Hospital, Shenzhen, China; Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, The University of Hong Kong, Hong Kong SAR, China; Center for Translational Stem Cell Biology, Hong Kong SAR, China.
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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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