Minimal coronary artery damage by myocardial electroporation ablation

Pré, Bastiaan C. du; Driel, Vincent J. van; Wessel, Harry van; Loh, Peter; Doevendans, Pieter A.; Goldschmeding, Roel; Wittkampf, Fred H.M.; Vink, Aryan

doi:10.1093/europace/eus171

Cited by 86 publications

(68 citation statements)

References 37 publications

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“…To date, successful applications of IRE to cardiac tissue, in addition to the pulmonary veins, includes the coronary vessels,40, 41 phrenic nerve,42 and ganglia 45. Apart from the novel application of IRE to Purkinje fibers, our study does support the work of others in that DC can be delivered to the beating heart.…”

Section: Discussionsupporting

confidence: 60%

“…The nonthermal nature of this technique provides a significant safety advantage by reducing the risk of collateral damage, which commonly occurs during ablation, especially if being used in the heart, where selective injury can target the tissue of interest yet potentially avoid coronary arteries40, 41 or extracardiac structures 38, 42, 43. Furthermore, stroke risk may also putatively be reduced because of the lack of coagulum formation, with electroporation compared with the heating that occurs with radiofrequency.…”

Section: Discussionmentioning

confidence: 99%

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Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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BackgroundThe Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation (IRE) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using IRE.Methods and ResultsIn an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90‐μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T‐wave method. IRE consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250–833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV (P=0.03). In 4 hearts after IRE delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J (P=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J.ConclusionsOur study highlights that Purkinje tissue can be ablated with IRE without any evidence of underlying myocardial damage.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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“…Apart from the ablated myocardial sleeve, only minor intimal hyperplasia was present, comparable with our findings with coronary arteries inside electroporation lesions. 4 Median sleeve coverage in these PVs was 0% at all 3 depths. With radiofrequency, the myocardial sleeve was totally absent in 9 of 20 sections, whereas with electroporation, the myocardial sleeve was absent in 14 of 17 sections (P=0.01; odds ratio, 16.96; 95% confidence interval, 2.0-142.7).…”

Section: Histological Analysismentioning

confidence: 82%

“…An external, monophasic defibrillator (Lifepak 9; PhysioControl Inc, Redmond, WA) was used for energy delivery. 1,3,4 During each application, current and voltage waveforms were recorded on a dual channel oscilloscope (Tektronix TDS 2002B, Beaverton, OR). For each ablation, a different position of the electroporation catheter was chosen to cover the complete tubular segment.…”

Section: Electroporation Ablationmentioning

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%