Biophysical and anatomical considerations for safe and efficacious catheter ablation of arrhythmias

Bardy, Gust H.; Sawyer, P. L.

doi:10.1002/clc.4960130611

Cited by 3 publications

(2 citation statements)

References 56 publications

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“…Standard DC causes electrolysis on the metal electrode surfaces in the blood pool, thus producing micro bubbles containing the gaseous products of electrolysis. Arcing is another phenomenon that occurs when a critical electric current density between the electrode and surrounding blood is reached; the resulting flash or arc leads to a transient temperature rise up to a thousand within the bubble [69] . In 2011, Wittkampf et al [28] explored low-energy DC with a modified electrode configuration and reported the creation of myocardial lesions without arcing and only small gas bubbles that adhered to the metal electrode surface and disappeared within a few seconds.…”

Section: Limitations Associated With Ire Ablationmentioning

confidence: 99%

“…Arcing is another phenomenon that occurs when a critical electric current density between the electrode and surrounding blood is reached; the resulting flash or arc leads to a transient temperature rise up to a thousand within the bubble. [69] In 2011, Wittkampf et al [28] explored low-energy DC with a modified electrode configuration and reported the creation of myocardial lesions without arcing and only small gas bubbles that adhered to the metal electrode surface and disappeared within a few seconds. Furthermore, using a lowenergy PEF protocol, in 2019, Reddy et al [36] reported no arcing or significant visible bubble formation.…”

Section: Involuntary Muscle Contractionsmentioning

confidence: 99%

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Irreversible Electroporation Ablation for Atrial Fibrillation: Status and Challenges

Xie¹,

Chen²,

Chen

et al. 2022

Cardiology Discovery

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Pulsed electric field (PEF) is a novel energy source by which high-voltage electric pulses are used to create irreversible electroporation. PEF is non-thermal and highly tissue-dependent in which specific targeting of the atrial myocardium is achieved and sparing of adjacent tissues is feasible, theoretically increasing the safety of the procedure, which could potentially break the trade-off between effective lesions and collateral damage and substantially improve risk-benefit ratios in atrial fibrillation (AF) ablation. Although recently published trials have shown a clear effect of AF ablation, large-scale clinical trials are lacking. Current clinical evidence has demonstrated significant efficacy in achieving durable pulmonary vein isolation without ablation-related adverse events. However, their putative benefits regarding efficacy, efficiency, and safety remain to be proven in randomized controlled trials.

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Section: Limitations Associated With Ire Ablationmentioning

confidence: 99%

Section: Involuntary Muscle Contractionsmentioning

confidence: 99%

Irreversible Electroporation Ablation for Atrial Fibrillation: Status and Challenges

Xie¹,

Chen²,

Chen

et al. 2022

Cardiology Discovery

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Cell-attached patch clamp study of the electropermeabilization of amphibian cardiac cells

O'Neill¹,

Tung²

1991

Biophysical Journal

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Potential gradients imposed across cell or lipid membranes break down the insulating properties of these barriers if an intensity and time-dependent threshold is exceeded. Potential gradients of this magnitude may occur throughout the body, and in particular in cardiac tissue, during clinical defibrillation, ablation, and electrocution trauma. To study the dynamics of membrane electropermeabilization a cell-attached patch clamp technique was used to directly control the potential across membrane patches of single ventricular cells enzymatically isolated from frog (Rana pipiens) hearts. Ramp waveshapes were used to reveal rapid membrane conductance changes that may have otherwise been obscured using rectangular waveshapes. We observed a step increase (delta t less than 30 microseconds) or breakdown in membrane conductance at transmembrane potential thresholds of 0.6-1.1 V in response to 0.1-1.0 kV/s voltage ramps. Conductance kinetics on a sub-millisecond time scale indicate that breakdown is preceded by a period of instability during which the noise and amplitude of the membrane conductance begin to increase. In some cells membrane breakdown was observed to be fully reversible when using an intershock interval of 1 min (20-23 degrees C). These findings support energetic models of membrane electropermeabilization which describe the formation of membrane pores (or growth of existing pores) to a conducting state (instability), followed by a rapid expansion of these pores when the energy barrier for the formation of hydrophilic pores is overcome (breakdown).

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Transesophageal Echocardiography to Improve Positioning of Radiofrequency Ablation Catheters in Left‐Sided Wolff‐Parkinson‐White Syndrome

Goldman

Irwin

Glover

et al. 1991

Pacing Clinical Electrophis

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Two patients with the Wolff-Parkinson-White syndrome who underwent successful radiofrequency catheter ablation of their left-sided bypass tracts are described. Transesophageal echocardiography, a relatively new echocardiographic technique, was utilized in both patients and provided excellent visualization of intracardiac anatomy as well as the catheter tip. Transesophageal echocardiography was also synergistic with fluoroscopy and the intracardiac electrogram in providing more precise catheter placement. In addition, the use of transesophageal echocardiography may reduce fluoroscopic exposure and shorten the procedure time.

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Biophysical and anatomical considerations for safe and efficacious catheter ablation of arrhythmias

Cited by 3 publications

References 56 publications

Irreversible Electroporation Ablation for Atrial Fibrillation: Status and Challenges

Irreversible Electroporation Ablation for Atrial Fibrillation: Status and Challenges

Cell-attached patch clamp study of the electropermeabilization of amphibian cardiac cells

Transesophageal Echocardiography to Improve Positioning of Radiofrequency Ablation Catheters in Left‐Sided Wolff‐Parkinson‐White Syndrome

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