Endocardial ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Issue 3 (26th December 2019)

• Record Type: Journal Article
• Authors: Koruth, Jacob S; Kuroki, Kenji; Iwasawa, Jin; Viswanathan, Raju; Brose, Richard; Buck, Eric D; Donskoy, Elina; Dukkipati, Srinivas R; Reddy, Vivek Y
• Is Part Of: Europace. Volume 22:Issue 3(2020)
• Page Start: 434
• Page End: 439
• Publication Date: 2019-12-26
• Subjects: Ventricular tachycardia -- Catheter ablation -- Pulsed field ablation -- Electroporation -- Ventricle; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euz341
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Pulsed field ablation (PFA) is a novel, non-thermal modality that selectively ablates myocardium with ultra-short electrical impulses while sparing collateral tissues. In a proof-of-concept study, the safety and feasibility of ventricular PFA were assessed using a prototype steerable, endocardial catheter. Methods and results: Under general anaesthesia, the left and right ventricles of four healthy swine were ablated using the 12-Fr deflectable PFA catheter and a deflectable sheath guided by electroanatomic mapping. Using the study catheter, electrograms were recorded for each site and pre-ablation and post-ablation pacing thresholds (at 2.0 ms pulse width) were recorded in two of four animals. After euthanasia at 35.5 days, the hearts were submitted for histology. The PFA applications ( n = 39) resulted in significant electrogram reduction without ventricular arrhythmias. In ablation sites where it was measured, the pacing thresholds increased by >16.8 mA in the right ventricle (3 sites) and >16.1 mA in the left ventricle (7 sites), with non-capture at maximum amplitude (20 mA) observable in 8 of 10 sites. Gross measurements, available for 28 of 30 ablation sites, revealed average lesion dimensions to be 6.5 ± 1.7 mm deep by 22.6 ± 4.1 mm wide, with a maximum depth and width of 9.4 mm and 28.6 mm, respectively. In the PFA lesions, fibrous tissue homogeneously replaced myocytes with a narrow zone of surrounding myocytolysis and no overlying thrombus. When present, nerve fascicles and vasculature were preserved within surrounding fibrosis. Conclusion: We demonstrate that endocardial PFA can be focally delivered using this prototype catheter to create homogeneous, myocardium-specific lesions. Graphical Abstract: