AC pulsed field ablation is effective and safe in atrial and ventricular settings: a proof-of-concept chronic animal study

článek v časopise ve Web of Science, Jimp

angličtina

Introduction: Pulsed field ablation (PFA) exploits the delivery of short high-power shocks to induce cells death via irreversible electroporation. The therapy offers a potential paradigm shift for catheter ablation of cardiac arrhythmia. We selected the AC-burst as a pulse with optimal combined benefits. We performed a proof-of-concept chronic animal trial to test the feasibility, safety and efficacy of our method and technology. Methods: We employed 6 female swine - weight 53.75±4.77 kg – in this study. With fluoroscopic and electroanatomical mapping assistance, we performed ECG-gated AC-PFA in the following settings: in the left atrium with a decapolar loop catheter with electrodes connected in bipolar fashion; across the interventricular septum applying energy between the distal electrodes of two tip catheters. After procedure and 4-week follow-up, the animals were euthanized, and the hearts were inspected for tissue changes and characterized. We perform finite element method simulation of our AC-PFA scenarios to corroborate our method and better interpret our findings. Results: We applied 60 square AC-bursts of 100 µs duration, 100 kHz internal frequency, 900 V for 60 pulses in the atrium and 1500 V for 120 pulses in the septum. Acute changes in the atrial and ventricular electrograms were immediately visible at the sites of AC-PFA – signals were elongated and reduced in amplitude (p<0.0001) and tissue impedance dropped (p=0.011). No adverse event (e.g. esophageal temperature rises or gas bubble streams) was observed. The implemented numerical simulations confirmed the non-thermal nature of our AC-PFA and provided specific information on the estimated treated area and need of pulse trains. The postmortem chest inspection showed no peripheral damage, but epicardial and endocardial discolorations at sites of ablation. T1-weighted scans revealed specific tissue changes in atria and ventricles, confirmed to be fibrotic scars via trichrome staining. We found isolated, transmural and continuous scars. A surviving cardiomyocyte core was visible in basal ventricular lesions. Conclusions: We proved that our method and technology of AC-PFA is effective and safe for atrial and ventricular myocardial ablation, supporting their application in the treatment of cardiac arrhythmia. Further optimization, with energy titration or longer follow-up, is required for a robust ventricular AC-PFA.

pulsed field ablation, irreversible electroporation (IRE), radiofrequency ablation, atrial fibrillation, ventricular arrhythmia (VA), preclinical cardiology.

CALUORI, G.; ODEHNALOVÁ, E.; JADCZYK, T.; PEŠL, M.; PAVLOVÁ, I.; VALÍKOVÁ, L.; HOLZINGER, S.; NOVOTNÁ, V.; ROTREKL,V.; HAMPL, A.; CRHA, M.; ČERVINKA, D.; STÁREK, Z.

3. 12. 2020

Frontiers in Bioengineering and Biotechnology

2296-4185

Frontiers in Bioengineering and Biotechnology

8

Švýcarská konfederace

1

27

27

https://www.frontiersin.org/articles/10.3389/fbioe.2020.552357/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Bioengineering_and_Biotechnology&id=552357