Feasibility of Electroporation for the Creation of Pulmonary Vein Ostial Lesions

Wittkampf, Fred H.M.; Driel, Vincent J. van; Wessel, Harry van; Vink, Aryan; Hof, Irene E.; Gründeman, Paul F.; Hauer, Richard N.W.; Loh, Peter

doi:10.1111/j.1540-8167.2010.01863.x

Cited by 71 publications

(72 citation statements)

References 26 publications

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“…A group in the Netherlands has laid much of the groundwork for study in the field of cardiac electroporation and previously performed DC ablation in the PVs 18. Results from our study and their previous studies validate the same concept: that IRE can be delivered in the PVs without significant adverse effects.…”

Section: Discussionsupporting

confidence: 75%

“…Further, it has been tested in animal models for treatment of cardiac disease by our group and others 10, 11, 12, 13, 14, 15, 16, 17, 18. Preliminary studies suggest that IRE may be a promising alternative ablation method for AF management.…”

Section: Introductionmentioning

confidence: 99%

“…Preliminary studies suggest that IRE may be a promising alternative ablation method for AF management. First, IRE could potentially be used to directly treat the triggers in the PVs without causing stenosis 10, 11, 18. Second, risk of other collateral damage, such as esophageal injury, may be lower as well because of the absence of high temperatures.…”

Section: Introductionmentioning

confidence: 99%

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Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach

Witt

Sugrue

Padmanabhan

et al. 2018

JAHA

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BackgroundCurrent thermal ablation methods for atrial fibrillation, including radiofrequency and cryoablation, have a suboptimal success rate. To avoid pulmonary vein (PV) stenosis, ablation is performed outside of the PV, despite the importance of triggers inside the vein. We previously reported on the acute effects of a novel direct current electroporation approach with a balloon catheter to create lesions inside the PVs in addition to the antrum. In this study, we aimed to determine whether the effects created by this nonthermal ablation method were associated with irreversible lesions and whether PV stenosis or other adverse effects occurred after a survival period.Methods and ResultsInitial and survival studies were performed in 5 canines. At the initial study, the balloon catheter was inflated to contact the antrum and interior of the PV. Direct current energy was delivered between 2 electrodes on the catheter in ECG‐gated 100 μs pulses. A total of 10 PVs were treated demonstrating significant acute local electrogram diminution (mean amplitude decrease of 61.2±19.8%). After the survival period (mean 27 days), computed tomography imaging showed no PV stenosis. On histologic evaluation, transmural, although not circumferential, lesions were seen in each treated vein. No PV stenosis or esophageal injury was present.ConclusionsIrreversible, transmural lesions can be created inside the PV without evidence of stenosis after a 27‐day survival period using this balloon‐based direct current ablation approach. These early data show promise for an ablation approach that could directly treat PV triggers in addition to traditional PV antrum ablation.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach

Witt

Sugrue

Padmanabhan

et al. 2018

JAHA

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“…One to 4 sequential, nonarcing, electroporation applications of 200 J eliminated PV electrograms in most ostia. 1 However, the long-term risk of PV stenosis after electroporation ablation is still unknown.…”

mentioning

confidence: 99%

Pulmonary Vein Stenosis After Catheter Ablation

Driel

Neven

Wessel

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Radiofrequency ablation inside pulmonary vein (PV) ostia can cause PV stenosis. A novel alternative method of ablation is irreversible electroporation, but the long-term response of PVs to electroporation ablation is unknown. Methods and Results-In ten 6-month-old pigs (60-75 kg), the response of PVs to circular electroporation and radiofrequency ablation was compared. Ten consecutive, nonarcing, electroporation applications of 200 J were delivered 5 to 10 mm inside 1 of the 2 main PVs, using a custom-deflectable, 18-mm circular decapolar catheter. Inside the other PV, circular radiofrequency ablation was performed using 30 W radiofrequency applications via an irrigated 4-mm ablation catheter. PV angiograms were made before ablation, immediately after ablation, and after 3-month survival. PV diameters and heart size were measured. With electroporation ablation, PV ostial diameter decreased 11±10% directly after ablation, but had increased 19±11% after 3 months. With radiofrequency ablation, PV ostial diameter decreased 23±15% directly after ablation and remained 7±17% smaller after 3 months compared with preablation diameter despite a 21±7% increase in heart size during aging from 6 to 9 months. Conclusions-In this porcine model, multiple circumferential 200-J electroporation applications inside the PV ostia do not affect PV diameter at 3-month follow-up. Radiofrequency ablation inside PV ostia causes considerable PV stenosis directly after ablation, which persists after 3 months. (Circ Arrhythm Electrophysiol. 2014;7:734-738.)

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“…IRE can be safety and feasibly applied to cardiac tissue, in particular pulmonary vein tissue. Data show that the existence of the ability to create durable transmural lesions [62][63][64][65][66][67] without damage to the surrounding structures. [68][69][70][71][72] More recently, our group has published data on a novel prototype catheter that can assist in performing IRE in the pulmonary veins/atrial tissue.…”

Section: Novel Ablation Modalities On the Horizonmentioning

confidence: 99%

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

Vaidya¹,

Sugure²,

Asirvatham³

2017

J Innov Cardiac Rhythm Manage

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Feasibility of Electroporation for the Creation of Pulmonary Vein Ostial Lesions

Abstract: Data suggest that electroporation can safely be used to create lesions in a sensitive environment like PV ostia.

Cited by 71 publications

References 26 publications

Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach

Intrapulmonary Vein Ablation Without Stenosis: A Novel Balloon‐Based Direct Current Electroporation Approach

Pulmonary Vein Stenosis After Catheter Ablation

Innovations in Clinical Cardiac Electrophysiology: Challenges and Upcoming Solutions in 2018 and Beyond

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